Provider Demographics
NPI:1093700486
Name:HANSON, RANDALL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4907
Mailing Address - Country:US
Mailing Address - Phone:515-241-5785
Mailing Address - Fax:515-241-4415
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:STE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-6472
Practice Address - Fax:515-241-3456
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA18170207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA03839Medicare UPIN