Healthcare Provider Details

I. General information

NPI: 1265620520
Provider Name (Legal Business Name): RAYMOND D.HANSEN M D P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 BAYSHORE BLVD
DUNEDIN FL
34698-2577
US

IV. Provider business mailing address

1972 BAYSHORE BLVD
DUNEDIN FL
34698-2577
US

V. Phone/Fax

Practice location:
  • Phone: 727-736-2513
  • Fax: 727-734-4701
Mailing address:
  • Phone: 727-736-2513
  • Fax: 727-734-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. RAYMOND. DANIEL HANSEN
Title or Position: OWNER
Credential: M.D.
Phone: 727-736-2513