Healthcare Provider Details

I. General information

NPI: 1700876216
Provider Name (Legal Business Name): PAMELA A HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOONER RD
BARTLESVILLE OK
74003-1524
US

IV. Provider business mailing address

204 BEECHER LN
BARTLESVILLE OK
74006-2185
US

V. Phone/Fax

Practice location:
  • Phone: 918-440-7692
  • Fax:
Mailing address:
  • Phone: 608-797-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: