MEDICARE: ROBIN DALE HANSON 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	2080P0207X	Pediatric Hematology & Oncology Physician	104100	MO

General Provider Information

NPI Number	:	1396719100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN DALE HANSON M.D.

Provider Business Mailing Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 2415
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8219
Country	:	US
Telephone Number	:	314-251-6986
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 2415
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8219
Country	:	US
Telephone Number	:	314-251-6986
Fax Number	:

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	10/17/2011

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