Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2007-00601 | NC |
Y | 207N00000X | Dermatologist | 364336-1205 | UT |
N | 207ND0101X | MOHS-Micrographic Surgeon | 2007-00601 | NC |
N | 207ND0900X | Dermatopathologist | 2007-00601 | NC |
N | 207NS0135X | Procedural Dermatology | 2007-00601 | NC |
NPI | 1285734822 |
---|---|
Provider Name | Dr. Jason Hansen |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Salt Lake City, UT 84105-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 09/06/2011 |