Provider Demographics
NPI:1154396570
Name:HANSEN, ERIC THEODORE (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:THEODORE
Last Name:HANSEN
Suffix:
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:PO BOX 5845
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5845
Mailing Address - Country:US
Mailing Address - Phone:425-462-9800
Mailing Address - Fax:425-454-9143
Practice Address - Street 1:1427 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3035
Practice Address - Country:US
Practice Address - Phone:425-462-9800
Practice Address - Fax:425-454-9143
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD218878207X00000X
WAMD00039438207X00000X, 207XX0004X
MEMD23765207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8327751Medicaid
WA8327751Medicaid
OR269964Medicaid
WA8327751Medicaid