Organization
KENT O HANSON, MD, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT OSCAR HANSON MD (OWNER)
(602) 264-5359
Entity
Organization
Contact information
Practice address
2601 N 3RD ST, SUITE #308, PHOENIX, AZ 85004-1104
(602) 264-5959
(602) 279-7433
Mailing address
2601 N 3RD ST, SUITE #308, PHOENIX, AZ 85004-1104
(602) 264-5959
(602) 279-7433
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D09311231
CLIA
AZ
01
—
1Z7476
HEALTH NET
AZ
01
—
2784
AZ LICENSE
AZ
01
—
AZ0015000
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
09/04/2007
Last updated
09/04/2007
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