Healthcare Provider Details

I. General information

NPI: 1154396570
Provider Name (Legal Business Name): ERIC THEODORE HANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 116TH AVE NE
BELLEVUE WA
98004-3035
US

IV. Provider business mailing address

PO BOX 5845
PORTLAND OR
97228-5845
US

V. Phone/Fax

Practice location:
  • Phone: 425-462-9800
  • Fax: 425-454-9143
Mailing address:
  • Phone: 425-462-9800
  • Fax: 425-454-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD218878
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00039438
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD23765
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD00039438
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: