Provider Demographics
NPI:1316990740
Name:HANSEN, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:5580 NORDIC PL
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9138
Practice Address - Country:US
Practice Address - Phone:360-384-1511
Practice Address - Fax:360-384-5758
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAML20007743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8456972Medicaid
WAP00476409OtherRAILROAD MEDICARE
WA8941952OtherLABOR & INDUSTRIES (CV)
WA3976HAOtherREGENCE
WA423898050OtherGROUP HEALTH
WAI55192Medicare UPIN
WA423898050OtherGROUP HEALTH