Healthcare Provider Details

I. General information

NPI: 1407821317
Provider Name (Legal Business Name): ROBERT M HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 BUENAVENTURA BLVD SUITE 100
REDDING CA
96001-0160
US

IV. Provider business mailing address

3116 W MARCH LN SUITE 200
STOCKTON CA
95219-2370
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-3164
  • Fax: 530-245-0849
Mailing address:
  • Phone: 209-473-6555
  • Fax: 209-473-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG047619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: