MEDICARE: BRUCE M HANSEN DO ANESTHESIA PC

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	207L00000X	Anesthesiology Physician	TL#1168	WY

General Provider Information

NPI Number	:	1417188046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE M HANSEN DO ANESTHESIA PC

Provider Business Mailing Address
First Line	:	2510 E 15TH ST
Second Line	:	SUITE 2
City	:	CASPER
State	:	WY
Zip	:	82609-4111
Country	:	US
Telephone Number	:	307-234-9657
Fax Number	:	307-234-0306

Provider Business Practice Location Address
First Line	:	2510 E 15TH ST
Second Line	:	SUITE 2
City	:	CASPER
State	:	WY
Zip	:	82609-4111
Country	:	US
Telephone Number	:	307-234-9657
Fax Number	:	307-234-0306

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE M HANSEN
Credential	:	DO
Telephone Number	:	307-234-9657

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	05/07/2012

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