Healthcare Provider Details

I. General information

NPI: 1154386472
Provider Name (Legal Business Name): HEDRIC B HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 PROVIDENCE DR SUITE 425
ANCHORAGE AK
99508-4615
US

IV. Provider business mailing address

3260 PROVIDENCE DR SUITE 425
ANCHORAGE AK
99508-4615
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-7111
  • Fax: 907-561-1304
Mailing address:
  • Phone: 907-561-7111
  • Fax: 907-561-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number1158
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: