=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952417990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRIN F. HANSEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 10/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 96 E KIMBALLS LN STE 409
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-523-6177
-----------------------------------------------------
Fax | 801-660-2492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 E KIMBALLS LN STE 409
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-523-6177
-----------------------------------------------------
Fax | 801-660-2492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 372807-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 372807-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------