Individual
JOSHUA TED HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
132 5TH AVE W, JEROME, ID 83338-1825
(208) 814-9800
(208) 933-9648
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1656
ID
Other
Enumeration date
04/02/2016
Last updated
06/13/2022
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