Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 34-00-8163H | OH |
Y | 207N00000X | Dermatologist | 7021 | SD |
N | 207NS0135X | Procedural Dermatology | 34-00-8163H | OH |
N | 207NS0135X | Procedural Dermatology | 7021 | SD |
NPI | 1396804597 |
---|---|
Provider Name | Dr. Ty Hanson |
First Address | Aberdeen, SD 57401-4552 |
Second Address | Aberdeen, SD 57401-4552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 19/07/2007 |