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General NPI Number Information
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NPI Number | 1629142187
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Entity Type | Individual
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Provider Name | THOMAS R. HANSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 313 REED BLVD
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City | MILL VALLEY
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State | CA
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Zip | 94941-2566
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Country | US
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Telephone | 415-336-6341
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Fax |
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Provider Business Mailing Address
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Address Line | 313 REED BLVD
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City | MILL VALLEY
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State | CA
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Zip | 94941-2566
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Country | US
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Telephone | 415-336-6341
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G85011
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License Number State | CA
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