Healthcare Provider Details

I. General information

NPI: 1619971074
Provider Name (Legal Business Name): KARL NEAL HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE STE 307
KENNER LA
70065-2474
US

IV. Provider business mailing address

200 W ESPLANADE AVE STE 307
KENNER LA
70065-2474
US

V. Phone/Fax

Practice location:
  • Phone: 504-467-3404
  • Fax: 504-467-3244
Mailing address:
  • Phone: 504-467-3404
  • Fax: 504-467-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberL017687
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: