Provider Demographics
NPI:1700197498
Name:HANSON, TRAVIS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOHN
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 1:1301 S CLIFF AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1032
Mailing Address - Country:US
Mailing Address - Phone:605-322-6930
Mailing Address - Fax:
Practice Address - Street 1:1301 S CLIFF AVE STE 601
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6243207R00000X
SD10002207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine