Healthcare Provider Details

I. General information

NPI: 1255858403
Provider Name (Legal Business Name): LOGAN MATHEW HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL
AURORA CO
80045-2570
US

IV. Provider business mailing address

13001 E 17TH PL
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0076938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: