Healthcare Provider Details

I. General information

NPI: 1457730962
Provider Name (Legal Business Name): JOEY HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 UNIVERSITY PARK BLVD
LAYTON UT
84041-1611
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-6200
  • Fax:
Mailing address:
  • Phone: 801-821-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9873472-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: