Organization
DWAYNE M. HANSEN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE M. HANSEN MD (OWNER)
(208) 656-8442
Entity
Organization
Contact information
Practice address
381 EAST 4TH NORTH STREET, SUITE 100, REXBURG, ID 83440
(208) 656-8442
(208) 656-8453
Mailing address
PO BOX 185, REXBURG, ID 83440-0185
(208) 656-8442
(208) 656-8453
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
09/19/2006
Last updated
12/06/2007
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