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General NPI Number Information
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NPI Number | 1508183989
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Entity Type | Individual
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Provider Name | TERRY LEONID HANSEN MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 201 CEDAR ST SE STE 6600
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City | ALBUQUERQUE
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State | NM
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Zip | 87106
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Country | US
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Telephone | 505-724-4300
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Fax | 505-724-4384
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Provider Business Mailing Address
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Address Line | 1540 JUAN TABO BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-4460
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Country | US
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Telephone | 505-800-7246
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Fax | 505-207-5221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD2015-0101
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License Number State | NM
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