Healthcare Provider Details

I. General information

NPI: 1447485123
Provider Name (Legal Business Name): DANIEL J. HANSEN, D.O., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 07/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 E RIDGELINE DR
SOUTH OGDEN UT
84405-4976
US

IV. Provider business mailing address

1495 E RIDGELINE DR
SOUTH OGDEN UT
84405-4976
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-3324
  • Fax: 801-394-2807
Mailing address:
  • Phone: 801-399-3324
  • Fax: 801-394-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number71920331204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number71920331204
License Number StateUT

VIII. Authorized Official

Name: DR. DANIEL JOSEPH HANSEN
Title or Position: PHYSICIAN OWNER
Credential: D.O.
Phone: 801-399-3324