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General NPI Number Information
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NPI Number | 1215137963
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Entity Type | Organization
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Legal Business Name | JERRY A. HANSON, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 2030 FOREST AVE STE. 210
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City | SAN JOSE
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State | CA
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Zip | 95128-4833
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Country | US
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Telephone | 408-295-2257
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Fax | 408-295-2264
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Provider Business Mailing Address
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Address Line | 2030 FOREST AVE STE. 210
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City | SAN JOSE
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State | CA
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Zip | 95128-4833
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Country | US
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Telephone | 408-295-2257
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Fax | 408-295-2264
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY ALAN HANSON
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Credential | M.D.
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Telephone | 48-295-2257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C33389
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License Number State | CA
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