Provider Demographics
NPI:1073521977
Name:HANSEN, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12330 METCALF AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1324
Mailing Address - Country:US
Mailing Address - Phone:913-491-1616
Mailing Address - Fax:913-491-8061
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-491-1616
Practice Address - Fax:913-491-8061
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0429103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100400020AMedicaid
KS100400020BMedicaid
KS101157OtherBLUE CROSS BLUE SHIELD
D05F416OtherMEDICARE
KS7703264OtherAETNA
KS7703264OtherAETNA