Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1608301205 | UT |
NPI | 1235212192 |
---|---|
Provider Name | Dr. Scott F Hansen |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Slc, UT 84103-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 09/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
942854057012 | (05) | UT |
E04591 | (02) | UT |