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General NPI Number Information
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NPI Number | 1528004777
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Entity Type | Individual
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Provider Name | THOMAS S HANSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1 MEMORIAL DR
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City | ALTON
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State | IL
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Zip | 62002-6755
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Country | US
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Telephone | 618-463-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 938 MCPHERSON AVE
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City | ALTON
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State | IL
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Zip | 62002-2256
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Country | US
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Telephone | 618-462-4281
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-090592
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-090592
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License Number State | IL
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