Provider Demographics
NPI:1790739092
Name:HANSON, RONALD WAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:HANSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6636 CEDAR AVE S STE 170
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2710
Mailing Address - Country:US
Mailing Address - Phone:612-800-5096
Mailing Address - Fax:877-511-7874
Practice Address - Street 1:6636 CEDAR AVE S STE 170
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2710
Practice Address - Country:US
Practice Address - Phone:612-800-5096
Practice Address - Fax:877-511-7874
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-10-21
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Provider Licenses
StateLicense IDTaxonomies
CO48888207QS0010X
MN49997207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine