Provider Demographics
NPI:1104881945
Name:HANSEN, HENRY ANDREW II (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:ANDREW
Last Name:HANSEN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 FOREST LN # 515057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2472
Mailing Address - Country:US
Mailing Address - Phone:469-850-5760
Mailing Address - Fax:
Practice Address - Street 1:8000 RESEARCH FOREST DR STE 250
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1507
Practice Address - Country:US
Practice Address - Phone:281-571-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4384208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340739OtherGROUP MEDICARE PTAN
TXDV0090OtherMEDICARE RAILROAD GROUP PTAN
TX128605607Medicaid
TX340731OtherGROUP MEDICARE PTAN
TXP01671333OtherMEDICARE RAILROAD INDIVIDUAL PTAN
TX0A3513OtherGROUP MEDICARE PTAN
TX128605607Medicaid
TX479550YY2GMedicare PIN
TX340739OtherGROUP MEDICARE PTAN
E13764Medicare UPIN