Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F1619 | TX |
N | 207XS0106X | Orthopaedic Hand Surgeon | F1619 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | F1619 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | F1619 | TX |
N | 207XX0801X | Orthopaedic Trauma Surgeon | F1619 | TX |
NPI | 1346230810 |
---|---|
Provider Name | Phillip E Hansen |
First Address | Dallas, TX 75246-1615 |
Second Address | Dallas, TX 75246-1615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 20/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042841901 | (05) | TX |
042841902 | (05) | TX |
840760 | BCBS (01) | TX |
C16562 | (02) |