Healthcare Provider Details

I. General information

NPI: 1861433443
Provider Name (Legal Business Name): THOMAS R HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: T RANDY HANSEN MD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3246
  • Fax: 928-425-3859
Mailing address:
  • Phone: 928-425-3246
  • Fax: 928-425-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1803601205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: