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NPI Code Detail

MEDICARE: DR. MARK T HANSEN M.D.

MEDICARE: DR. MARK T HANSEN 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
1208600000XSurgery Physician71681TN
2208600000XSurgery Physician358614-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1870591755HA1OTHERUTEMIA
2107008361102OTHERUTIHC
3344470OTHERUTDMBA
448410OTHERUTPEHP

General Provider Information

NPI Number : 1689646507
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK T HANSEN M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1350 N 500 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-2400
Country : US
Telephone Number : 435-716-1950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 11/11/2025

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Directions to “ DR. MARK T HANSEN M.D.” Practice Location

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