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General NPI Number Information
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NPI Number | 1437479920
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Entity Type | Organization
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Legal Business Name | ERIC HANSEN MD PC
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 150 ARROWHEAD DR SUITE 2
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City | EVANSTON
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State | WY
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Zip | 82930-9353
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Country | US
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Telephone | 307-789-8881
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Fax | 307-789-6470
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Provider Business Mailing Address
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Address Line | 150 ARROWHEAD DR SUITE 2
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City | EVANSTON
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State | WY
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Zip | 82930-9353
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Country | US
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Telephone | 307-789-8881
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Fax | 307-789-6470
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC CHRISTOPHER HANSEN
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Credential | MD
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Telephone | 307-789-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6429A
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License Number State | WY
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