Individual
DR. C DAVID HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-1100
(801) 581-2955
Mailing address
PO BOX 3208, SALT LAKE CITY, UT 84110-3208
(801) 587-6340
(801) 587-6346
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1608261205
UT
207ND0900X
Dermatopathology Physician
1608261205
UT
207NS0135X
Procedural Dermatology Physician
1608261205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003755200
—
ID
05
—
0061149
—
MT
05
—
100503100
—
NV
05
—
870468377001
—
UT
Enumeration date
09/15/2006
Last updated
11/02/2021
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