Provider Demographics
NPI:1699881748
Name:HANSON, GREGORY R (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1712
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:500 OSBORNE RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2765
Practice Address - Country:US
Practice Address - Phone:763-783-8582
Practice Address - Fax:763-783-8616
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-09-10
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Provider Licenses
StateLicense IDTaxonomies
MN49996208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00436573OtherRR MEDICARE
MN601125100Medicaid
MN601125100Medicaid
I62506Medicare UPIN