Healthcare Provider Details

I. General information

NPI: 1679736581
Provider Name (Legal Business Name): JAMES D HANSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10932 NE 6TH AVE
MIAMI FL
33161
US

IV. Provider business mailing address

10932 NE 6TH AVE
MIAMI FL
33161
US

V. Phone/Fax

Practice location:
  • Phone: 305-754-8613
  • Fax: 305-751-2941
Mailing address:
  • Phone: 305-754-8613
  • Fax: 305-751-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberME0009202
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES D HANSON
Title or Position: PRESIDENT
Credential: MD
Phone: 305-754-8613