Provider Demographics
NPI:1437183928
Name:HANSPETERSEN, JEFFREY T (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:HANSPETERSEN
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:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10030 SW 210TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6584
Practice Address - Country:US
Practice Address - Phone:206-463-3671
Practice Address - Fax:206-463-3613
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043102207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13547OtherBC
FLME92602OtherMEDICAL LICENSE
FL271956800Medicaid
FL13547OtherBC
FL101937Medicare ID - Type UnspecifiedUGS MC
FL13547OtherBC
FLP00295519Medicare ID - Type UnspecifiedRR MC