Provider Demographics
NPI:1558323964
Name:HANSEN, DAWN MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MAE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MAE
Other - Last Name:SCHOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2727
Mailing Address - Country:US
Mailing Address - Phone:850-233-3376
Mailing Address - Fax:850-522-8354
Practice Address - Street 1:2550 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2726
Practice Address - Country:US
Practice Address - Phone:228-207-2817
Practice Address - Fax:850-522-8354
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122062Medicaid
110001331Medicare ID - Type Unspecified
MS0122062Medicaid