Provider Demographics
NPI:1992735583
Name:HANSON, JONATHAN B (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
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:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E STATE ROAD 62 STE 2E
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0820
Practice Address - Fax:812-801-0027
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060659207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
788574OtherAETNA
IN059905OtherSIHO
IN000000364028OtherANTHEM BCBS
KY50007149OtherKY PASSPORT
KY64100803Medicaid
IN200517770CMedicaid
IN000000364028OtherANTHEM BCBS
IN000000364028OtherANTHEM BCBS
IN059905OtherSIHO