Healthcare Provider Details

I. General information

NPI: 1831337518
Provider Name (Legal Business Name): LEE C HANSON, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 CAMBERWELL CT
DES PERES MO
63131-2118
US

IV. Provider business mailing address

PO BOX 504839
SAINT LOUIS MO
63150-0001
US

V. Phone/Fax

Practice location:
  • Phone: 636-207-0537
  • Fax:
Mailing address:
  • Phone: 636-207-0537
  • Fax: 636-207-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2001010350
License Number StateMO

VIII. Authorized Official

Name: DR. LEE C HANSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 636-207-0537