Provider Demographics
NPI:1316945967
Name:HANSON, DAVID CONRAD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CONRAD
Last Name:HANSON
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 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE100
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-827-9631
Mailing Address - Fax:785-827-0217
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE100
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-827-9631
Practice Address - Fax:785-827-0217
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100168700DMedicaid
KSD05251Medicare UPIN
KS100168700DMedicaid