Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 1158 | AK |
NPI | 1154386472 |
---|---|
Provider Name | Hedric B Hanson |
First Address | Anchorage, AK 99508-4615 |
Second Address | Anchorage, AK 99508-4615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C97105 | (02) | AK |
MD1158 | (05) | AK |