Provider Demographics
NPI:1578726238
Name:W H HANSEN MD PA
Entity Type:Organization
Organization Name:W H HANSEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WINFRIED
Authorized Official - Middle Name:H
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-476-8467
Mailing Address - Street 1:2020 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8145
Mailing Address - Country:US
Mailing Address - Phone:850-476-8467
Mailing Address - Fax:850-476-8468
Practice Address - Street 1:2020 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8145
Practice Address - Country:US
Practice Address - Phone:850-476-8467
Practice Address - Fax:850-476-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
FLME24683261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP0824OtherMEDICARE RAILROAD
DP0824OtherMEDICARE RAILROAD