Healthcare Provider Details

I. General information

NPI: 1174636070
Provider Name (Legal Business Name): JOHN R HANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N MACARTHUR BLVD STE. 350
IRVING TX
75062-3636
US

IV. Provider business mailing address

3501 N MACARTHUR BLVD STE. 350
IRVING TX
75062-3636
US

V. Phone/Fax

Practice location:
  • Phone: 972-257-5300
  • Fax: 972-257-5322
Mailing address:
  • Phone: 972-257-5300
  • Fax: 972-257-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ3676
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: