Provider Demographics
NPI:1417182007
Name:HANSEN, DALE EUGENE III (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EUGENE
Last Name:HANSEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7695 POPLAR PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5947
Mailing Address - Country:US
Mailing Address - Phone:901-685-2696
Mailing Address - Fax:901-682-9747
Practice Address - Street 1:7695 POPLAR PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-5947
Practice Address - Country:US
Practice Address - Phone:901-685-2696
Practice Address - Fax:901-682-9747
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2016-08-03
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Provider Licenses
StateLicense IDTaxonomies
TN488312085R0204X
MS235062085R0204X
TNMD00000488312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology