Provider Demographics
NPI:1306230784
Name:HANSON, CODY (DO)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:
Last Name:HANSON
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 1:5204 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1211
Mailing Address - Country:US
Mailing Address - Phone:816-838-8180
Mailing Address - Fax:816-233-3983
Practice Address - Street 1:5204 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1211
Practice Address - Country:US
Practice Address - Phone:816-383-8180
Practice Address - Fax:816-233-3983
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2019011259207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program