Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DO-04912 | IA |
NPI | 1003173980 |
---|---|
Provider Name | Scott Thomas Hanson |
First Address | Des Moines, IA 50305-1475 |
Second Address | Des Moines, IA 50309-3106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 29/09/2016 |