MEDICARE: MATTHEW HANSMAN 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	208600000X	Surgery Physician	A83396	CA

General Provider Information

NPI Number	:	1831179704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW HANSMAN MD

Provider Business Mailing Address
First Line	:	2025 SOQUEL AVENUE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1323
Country	:	US
Telephone Number	:	831-458-6603
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 CHANTICLEER AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1815
Country	:	US
Telephone Number	:	831-479-6603
Fax Number	:

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	11/23/2011

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