Individual
DEREK THOMAS HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 687-1100
Mailing address
1324 LAKELAND HILLS BLVD., ATTN: MANAGED CARE DEPT., LAKELAND, FL 33805
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
856-L
MS
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
ME135265
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
856-L
TEMPORARY STATE MEDICAL LICENSE
MS
Enumeration date
06/29/2012
Last updated
05/31/2023
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