Healthcare Provider Details

I. General information

NPI: 1942256169
Provider Name (Legal Business Name): PETER A HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 TAHOE BLVD SUITE 207
INCLINE VILLAGE NV
89451-9451
US

IV. Provider business mailing address

590 MCDONALD DR
INCLINE VILLAGE NV
89451-9133
US

V. Phone/Fax

Practice location:
  • Phone: 775-833-2929
  • Fax: 775-833-0277
Mailing address:
  • Phone: 612-384-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13177
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number13177
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: