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Individual

DR. MATTHEW LERON HANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2940 E BANNER GATEWAY DR, SUITE 200, GILBERT, AZ 85234-2168
(480) 964-2908
(480) 833-2136
Mailing address
PO BOX 80217, PHOENIX, AZ 85060-0217
(602) 385-2115
(480) 418-3323

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
35613
AZ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
35613
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
112448
AZ
01
5550830001
MEDICARE NSC SCW
AZ
01
5550830003
MEDICARE NSC PEORIA
AZ
01
5550830004
MEDICARE NSC PV
AZ
01
5550830006
MEDICARE NSC ANTHEM
AZ
01
5550830007
MEDICARE NSC DV
AZ
01
5550830008
MEDICARE NSC SWV
AZ
01
5550830009
MEDICARE NSC AZ NORTH
AZ
01
5550830010
MEDICARE NSC GILBERT
AZ
01
P00346251
RR MEDICARE
AZ
Enumeration date
07/10/2006
Last updated
08/03/2022
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