Individual
DR. BRADLEY EVAN HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
851 TRAFALGAR CT STE 200E, MAITLAND, FL 32751-7420
(321) 422-7166
Mailing address
851 TRAFALGAR CT STE 200E, MAITLAND, FL 32751-7420
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
S3182
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME151495
FLORIDA MEDICAL LICENSE
FL
01
—
S3182
TEXAS MEDICAL BOARD
TX
Enumeration date
05/05/2014
Last updated
03/02/2022
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