Healthcare Provider Details

I. General information

NPI: 1245243567
Provider Name (Legal Business Name): CHARLES HARTMAN HANSON X M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SAN MIGUEL DR SUITE 15
WALNUT CREEK CA
94596-5279
US

IV. Provider business mailing address

1855 SAN MIGUEL DR SUITE 15
WALNUT CREEK CA
94596-5279
US

V. Phone/Fax

Practice location:
  • Phone: 925-930-8770
  • Fax: 925-930-9338
Mailing address:
  • Phone: 925-930-8770
  • Fax: 925-930-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG36822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: