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General NPI Number Information
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NPI Number | 1538277629
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Entity Type | Individual
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Provider Name | DAVID VICTOR HANSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 450 E MAIN ST
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City | REXBURG
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State | ID
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Zip | 83440-2048
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Country | US
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Telephone | 208-359-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 2935 N 4000 W
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City | REXBURG
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State | ID
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Zip | 83440-3159
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Country | US
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Telephone | 208-356-8581
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Fax | 208-356-3066
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M5709
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License Number State | ID
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