Individual
JEFFREY A HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12187 DEER FLAT RD, NAMPA, ID 83686-9119
(208) 880-0576
Mailing address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 463-3000
(208) 463-3079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5246
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004475
BLUE SHIELD
ID
05
—
002364400
—
ID
01
—
080036990
RAILROAD MEDICARE
ID
01
—
52464
BLUE CROSS
ID
01
—
806359900
HEALTHY CONNECTIONS
ID
Enumeration date
10/21/2005
Last updated
12/28/2023
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