MEDICARE: DR. HANS ERIC BENGTSON MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	M9852	TX
2	208VP0000X	Pain Medicine Physician	M9852	TX

General Provider Information

NPI Number	:	1245214212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANS ERIC BENGTSON MD

Provider Business Mailing Address
First Line	:	PO BOX 343
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78292-0343
Country	:	US
Telephone Number	:	830-627-3800
Fax Number	:	830-625-2235

Provider Business Practice Location Address
First Line	:	4316 JAMES CASEY ST
Second Line	:	BLDG B, SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78745-1116
Country	:	US
Telephone Number	:	512-498-1029
Fax Number	:	830-625-2235

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	03/09/2016

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