Provider Demographics
NPI:1386751634
Name:HANSEN, JEFFREY E (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 N FAIRGROUNDS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-8689
Mailing Address - Fax:435-637-1123
Practice Address - Street 1:200 N FAIRGROUNDS RD
Practice Address - Street 2:STE 2
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-8689
Practice Address - Fax:435-637-8689
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT289301-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1129410001Medicare NSC
U55586Medicare UPIN
UT000090518Medicare ID - Type Unspecified