Healthcare Provider Details

I. General information

NPI: 1396804597
Provider Name (Legal Business Name): TY HANSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LAFAYETTE ST S
ABERDEEN SD
57401-5524
US

IV. Provider business mailing address

3 LAFAYETTE ST S
ABERDEEN SD
57401-5524
US

V. Phone/Fax

Practice location:
  • Phone: 605-226-0560
  • Fax: 605-226-1653
Mailing address:
  • Phone: 605-226-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34-00-8163H
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number7021
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number34-00-8163H
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7021
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: