Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | E4385 | TX |
NPI | 1245698919 |
---|---|
Provider Name | Gregory Hanson |
First Address | Brenham, TX 77833-5890 |
Second Address | Brenham, TX 77833-5890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2016 |
Last Update Date | 09/02/2016 |