MEDICARE: JANA G HANSON 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	207R00000X	Internal Medicine Physician	G60495	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	1109232696	OTHER		RR MEDICARE LEGACY PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G604950	OTHER	CA	BLUE SHIELD OF CA PIN
2	ORR003	OTHER		SLO SELECT
3	635985	OTHER		FIRST HEALTH LEGACY PIN

General Provider Information

NPI Number	:	1508849894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA G HANSON MD

Provider Business Mailing Address
First Line	:	805 AEROVISTA PL
Second Line	:	SUITE 106
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7919
Country	:	US
Telephone Number	:	805-594-1240
Fax Number	:	805-549-1241

Provider Business Practice Location Address
First Line	:	805 AEROVISTA PL
Second Line	:	SUITE 106
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7919
Country	:	US
Telephone Number	:	805-594-1240
Fax Number	:	805-549-1241

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/26/2011

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Directions to “ JANA G HANSON MD” Practice Location

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