Doctor Name: | DR. MARIE J HAN |
NPI Number: | 1891773198 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 01059519A |
Business Practice Address: | 2200 Bergquist Dr Ste 1 Jbsa Lackland, TX - 782369907 |
Business Phone Number: | 2022923781 |
Business Fax Number: | |
Mailing Address: | 2200 Bergquist Dr, Ste 1 JBSA LACKLAND |
State: | TX |
Postal Code: | 782369907 |
Phone Number: | 2022923781 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2006 |
NPI Last Update Date: | 07/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01059519A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |