Healthcare Provider Details

I. General information

NPI: 1912377789
Provider Name (Legal Business Name): MR. MATTHEW HANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

IV. Provider business mailing address

4304 ALTON RD APT 334
MIAMI BEACH FL
33140-2885
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-3300
  • Fax:
Mailing address:
  • Phone: 561-371-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9324061
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9324061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: