Provider Demographics
NPI:1831145069
Name:HANSON, CARL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:L
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-838-7711
Mailing Address - Fax:509-747-4664
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 350
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-676-9913
Practice Address - Fax:208-666-0885
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-8369207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48052Medicare UPIN
ID1102916Medicare ID - Type Unspecified