Individual
DR. RAY WILLIAM HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2700
Mailing address
PO BOX 3568, IDAHO FALLS, ID 83403-3568
(208) 552-8573
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-9006
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313058
ALTIUS
ID
05
—
807127000
—
ID
01
—
B4851
BLUE CROSS OLD
ID
01
—
HB399
BLUE CROSS
ID
Enumeration date
05/05/2006
Last updated
06/03/2014
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