MEDICARE: DR. MARK FOSTER HANSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	30407	AZ

General Provider Information

NPI Number	:	1033173737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK FOSTER HANSEN M.D.

Provider Business Mailing Address
First Line	:	933 W MOON VALLEY DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-6220
Country	:	US
Telephone Number	:	602-564-1346
Fax Number	:

Provider Business Practice Location Address
First Line	:	14215 NORTH 2ND AVENUE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-6220
Country	:	US
Telephone Number	:	602-564-1346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/14/2011

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