Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | P000000821 | WA |
NPI | 1366574196 |
---|---|
Provider Name | William Henry Hanson |
First Address | College Place, WA 99324-1641 |
Second Address | Pasco, WA 99301-9189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 10/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U17003 | (02) |