Healthcare Provider Details

I. General information

NPI: 1184695637
Provider Name (Legal Business Name): VAUGHN W. HANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E ELIZABETH ST
FORT COLLINS CO
80524-4007
US

IV. Provider business mailing address

1200 E ELIZABETH ST
FORT COLLINS CO
80524-4007
US

V. Phone/Fax

Practice location:
  • Phone: 970-416-6286
  • Fax: 970-482-2635
Mailing address:
  • Phone: 970-416-6286
  • Fax: 970-482-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33449
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1334499
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: