Provider Demographics
NPI:1598012148
Name:HANSEN, DOUGLAS ODIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ODIN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 GESSNER RD STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2523
Mailing Address - Country:US
Mailing Address - Phone:832-668-5546
Mailing Address - Fax:713-832-3048
Practice Address - Street 1:915 GESSNER RD STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2523
Practice Address - Country:US
Practice Address - Phone:832-668-5546
Practice Address - Fax:713-832-3048
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT45-2012207XX0004X
TX2163213ES0103X, 213ES0103X
TXT25-2014213ES0000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2163OtherTEXAS TDLR