Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 7102972-1205 | UT |
NPI | 1164491460 |
---|---|
Provider Name | Stephen M Hansen |
First Address | St George, UT 84770-3853 |
Second Address | St George, UT 84770-3853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8425670 | (05) | WA |
I17974 | (02) |