Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G53645 | CA |
NPI | 1013990811 |
---|---|
Provider Name | Eric Hanson |
First Address | Fresno, CA 93720-3305 |
Second Address | Fresno, CA 93720-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 09/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0170279 | STATE OF WASHINGTON (01) | CA |
200045918 | RAILROAD MEDICARE (01) | CA |
E57843 | (02) | CA |