Provider Demographics
NPI:1083934533
Name:HANSEN, BRIAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1007
Mailing Address - Country:US
Mailing Address - Phone:605-322-8000
Mailing Address - Fax:605-322-8414
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-8000
Practice Address - Fax:605-322-8414
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8917207R00000X
MN56327207R00000X
SD12067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine