Provider Demographics
NPI:1619971074
Name:HANSON, KARL NEAL (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:NEAL
Last Name:HANSON
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 1:200 W ESPLANADE AVE
Mailing Address - Street 2:STE 307
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2474
Mailing Address - Country:US
Mailing Address - Phone:504-467-3404
Mailing Address - Fax:504-467-3244
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:STE 307
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2474
Practice Address - Country:US
Practice Address - Phone:504-467-3404
Practice Address - Fax:504-467-3244
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL017687207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1374776Medicaid
52773Medicare ID - Type Unspecified
B64122Medicare UPIN