Provider Demographics
NPI:1619047339
Name:HANSON, MIRIAM L (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:L
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 N MOPAC EXPY
Mailing Address - Street 2:BLDG. C, STE. 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2403
Mailing Address - Country:US
Mailing Address - Phone:512-837-3376
Mailing Address - Fax:512-837-3377
Practice Address - Street 1:12319 N MOPAC EXPY
Practice Address - Street 2:BLDG. C, STE. 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2403
Practice Address - Country:US
Practice Address - Phone:512-837-3376
Practice Address - Fax:512-837-3377
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6174207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology