Provider Demographics
NPI:1487695037
Name:HANSEN, THOMAS ERIC (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERIC
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 1:4375 BOOTH CALLOWAY RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8359
Mailing Address - Country:US
Mailing Address - Phone:817-616-0384
Mailing Address - Fax:817-616-0388
Practice Address - Street 1:4375 BOOTH CALLOWAY RD
Practice Address - Street 2:SUITE 410
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8359
Practice Address - Country:US
Practice Address - Phone:817-616-0384
Practice Address - Fax:817-616-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115297207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90615Medicare UPIN