Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME32434 | FL |
NPI | 1073515631 |
---|---|
Provider Name | Mr. Gary Paul Hansen |
First Address | Tallahassee, FL 32308-4620 |
Second Address | Tallahassee, FL 32308-4620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036688900 | (05) | FL |
D54595 | (02) |