Organization
RENEW MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID JEROME HANSON MD (OWNER)
(218) 770-1006
Entity
Organization
Contact information
Practice address
2829 UNIVERSITY DR S, FARGO, ND 58103-6050
(701) 404-9909
(877) 813-3081
Mailing address
2829 UNIVERSITY DR S STE 105, FARGO, ND 58103-6050
(701) 404-9909
(877) 813-3081
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
44547
MN
Other
Enumeration date
01/08/2013
Last updated
11/15/2019
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