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General NPI Number Information
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NPI Number | 1942256169
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Entity Type | Individual
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Provider Name | PETER A HANSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 930 TAHOE BLVD SUITE 207
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9451
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Country | US
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Telephone | 775-833-2929
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Fax | 775-833-0277
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Provider Business Mailing Address
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Address Line | 590 MCDONALD DR
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9133
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Country | US
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Telephone | 612-384-8891
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13177
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 13177
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License Number State | NV
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