Individual
ROGER VIKE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO PHD
Contact information
Practice address
319 E MAIN ST, PANORA, IA 50216-1064
(641) 755-2121
(641) 755-2314
Mailing address
PO BOX 1475, DES MOINES, IA 50306-1475
(515) 643-4973
(515) 643-2784
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3182
IA
208D00000X
General Practice Physician
3182
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0634816
—
IA
01
—
30652
WELLMARK BLUE SHIELD
IA
Enumeration date
07/29/2005
Last updated
09/18/2007
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