Provider Demographics
NPI:1720198203
Name:HANSEN, JAMES PETER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PETER
Last Name:HANSEN
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 1:1 SHRADER ST STE 550
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1034
Mailing Address - Country:US
Mailing Address - Phone:415-387-8031
Mailing Address - Fax:415-668-8325
Practice Address - Street 1:1 SHRADER ST STE 550
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1034
Practice Address - Country:US
Practice Address - Phone:415-387-8031
Practice Address - Fax:415-668-8325
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A418321Medicaid
CA00A418320Medicare ID - Type Unspecified
CA00A418321Medicaid