Individual
DR. DWAYNE M HANSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
381 EAST 4TH NORTH, STE 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
M8427
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48488
BLUE CROSS OF IDAHO
ID
01
—
CS9440
IDAHO STATE BOARD OF PHAR
ID
01
—
M8427
IDAHO STATE LICENSE
ID
Enumeration date
06/02/2006
Last updated
03/07/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us