Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AL5326 | FL |
Y | 213ES0000X | Sports Medicine | AL5326 | FL |
NPI | 1013553403 |
---|---|
Provider Name | Clayton W Hanson |
First Address | Bradenton, FL 34210-3506 |
Second Address | Bradenton, FL 34210-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2019 |
Last Update Date | 21/11/2019 |