Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 6217 | TX |
Y | 213ER0200X | Radiology | 6217 | TX |
NPI | 1811123821 |
---|---|
Provider Name | Dr. Kenneth Neil Hansen |
First Address | Dallas, TX 75230-8827 |
Second Address | Dallas, TX 75230-8827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2009 |
Last Update Date | 04/06/2009 |