Individual
MR. MATTHEW VERNON HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
221 3RD ST WEST, 12 MEDICAL GROUP, RANDOLPH, TX 78150-4801
(210) 652-9836
Mailing address
3331 TRAILWAY PARK, SAN ANTONIO, TX 78247
(210) 722-2274
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1025979
—
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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