Individual
DR. DAVID VICTOR HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 E MAIN ST, REXBURG, ID 83440-2048
(208) 359-6508
Mailing address
2935 N 4000 W, REXBURG, ID 83440-3159
(208) 356-8581
(208) 356-3066
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M5709
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115647-00
—
WY
Enumeration date
08/28/2006
Last updated
07/08/2007
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