Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00039438 | WA |
N | 207X00000X | Orthopaedic Surgeon | MD23765 | ME |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD00039438 | WA |
NPI | 1154396570 |
---|---|
Provider Name | Eric Theodore Hansen |
First Address | Portland, OR 97228-5845 |
Second Address | Bellevue, WA 98004-3035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 06/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8327751 | (05) | WA |
H77445 | (02) |