Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 60409 | WI |
N | 2080P0205X | Pediatric Endocrinologist | 01075810A | IN |
Y | 2080P0205X | Pediatric Endocrinologist | 292193 | NY |
NPI | 1003105768 |
---|---|
Provider Name | Dr. David William Hansen |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 07/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003105768 | (05) | IN |
1003105768 | (05) | WI |