Organization
BREAST CLINIC INC
Active
Organization
BREAST CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA LEE HANSON M.D (MEDICAL DIRECTOR)
(850) 863-2006
Entity
Organization
Contact information
Practice address
918 MAR WALT DR, FT WALTON BEACH, FL 32547-6706
(850) 863-2006
Mailing address
918 MAR WALT DR, FT WALTON BEACH, FL 32547-6706
(850) 863-2006
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D08079
RAILROAD MEDICARE PIN
—
Enumeration date
02/27/2006
Last updated
10/28/2011
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