Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | T45-2012 | TX |
N | 213EP1101X | Primary Podiatric Medicine | T25-2014 | TX |
N | 2081S0010X | Sports Medicine | T25-2014 | TX |
N | 213ES0000X | Sports Medicine | T25-2014 | TX |
Y | 213ES0103X | Foot & Ankle Surgery | T25-2014 | TX |
N | 213ES0131X | Foot Surgery | T25-2014 | TX |
NPI | 1598012148 |
---|---|
Provider Name | Dr. Douglas Odin Hansen |
First Address | Houston, TX 77081-5339 |
Second Address | Houston, TX 77081-5339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 09/07/2015 |