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NPI Code Detail

MEDICARE: MR. CALEB FRAZIER HANSON PA-C, ATC

MEDICARE: MR. CALEB FRAZIER HANSON PA-C, ATC
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
12255A2300XAthletic Trainer1977AL
2363AM0700XMedical Physician Assistant1926AL

General Provider Information

NPI Number : 1386179315
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CALEB FRAZIER HANSON PA-C, ATC
Provider Business Mailing Address
First Line : P.O. BOX 130
Second Line : 40W610 RT 64
City : WASCO
State : IL
Zip : 60183
Country : US
Telephone Number : 630-803-3936
Fax Number :
Provider Business Practice Location Address
First Line : 6701 AIRPORT BLVD STE A101
Second Line :
City : MOBILE
State : AL
Zip : 36608-6767
Country : US
Telephone Number : 251-378-3900
Fax Number : 251-378-3902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2017
Last Update Date : 08/15/2025

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