Healthcare Provider Details

I. General information

NPI: 1841415734
Provider Name (Legal Business Name): RYAN MARK HANSON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 W HOSPITAL DR SUITE #1
PRICE UT
84501-4214
US

IV. Provider business mailing address

945 W HOSPITAL DR SUITE #1
PRICE UT
84501-4214
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4327
  • Fax: 435-613-9709
Mailing address:
  • Phone: 435-637-4327
  • Fax: 435-613-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6265845-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: