Provider Demographics
NPI:1215268891
Name:ROBERT E. HANSON, M.D., P.A.
Entity type:Organization
Organization Name:ROBERT E. HANSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-3350
Mailing Address - Street 1:3470 FANNIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3816
Mailing Address - Country:US
Mailing Address - Phone:409-835-3350
Mailing Address - Fax:409-835-4403
Practice Address - Street 1:3470 FANNIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3816
Practice Address - Country:US
Practice Address - Phone:409-835-3350
Practice Address - Fax:409-835-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1329207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136312902Medicaid
TX136312902Medicaid
TXC16565Medicare UPIN