Healthcare Provider Details

I. General information

NPI: 1427084508
Provider Name (Legal Business Name): JOHN VERNON HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N SUITE 210W
BILLINGS MT
59101-7506
US

IV. Provider business mailing address

4608 PALISADES PARK DR
BILLINGS MT
59106-1354
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5862
  • Fax: 406-238-6068
Mailing address:
  • Phone: 406-237-5862
  • Fax: 406-238-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4626
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: