MEDICARE: DR. DOUGLAS HANZE PH.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	103TC0700X	Clinical Psychologist	512	CO

General Provider Information

NPI Number	:	1306931639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS HANZE PH.D.

Provider Business Mailing Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	# 4-170
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4300
Country	:	US
Telephone Number	:	303-933-9258
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	# 4-170
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4300
Country	:	US
Telephone Number	:	303-933-9258
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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