Provider Demographics
NPI:1114025749
Name:HANNA, FARES A (MD)
Entity type:Individual
Prefix:
First Name:FARES
Middle Name:A
Last Name:HANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FARIS
Other - Middle Name:A
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1150 N 35TH AVE STE 675
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5472
Mailing Address - Country:US
Mailing Address - Phone:954-966-2133
Mailing Address - Fax:954-961-0959
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:675
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-966-2133
Practice Address - Fax:954-961-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371017300Medicaid
FLME56896OtherSTATE
FLME56896OtherSTATE