Healthcare Provider Details

I. General information

NPI: 1508183989
Provider Name (Legal Business Name): TERRY LEONID HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEONID TERRY HANSEN MD

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 6600
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1540 JUAN TABO BLVD NE STE A
ALBUQUERQUE NM
87112-4460
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-724-4384
Mailing address:
  • Phone: 505-800-7246
  • Fax: 505-207-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD2015-0101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: