Provider Demographics
NPI:1275643447
Name:HANSEN, SCOTT MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MATTHEW
Last Name:HANSEN
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 1:1100 OLIVE WAY
Mailing Address - Street 2:MS: M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 OLIVE WAY
Practice Address - Street 2:SUITE 531
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1873
Practice Address - Country:US
Practice Address - Phone:206-223-6762
Practice Address - Fax:206-625-7414
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000468322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00432OtherALASKA MEDICAID
WA8520462Medicaid
WAMD00432OtherALASKA MEDICAID
WA8520462Medicaid