Provider Demographics
NPI:1881678738
Name:HANSEN, DUWAYNE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUWAYNE
Middle Name:ALLEN
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 1:1861 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-2303
Mailing Address - Country:US
Mailing Address - Phone:507-238-2985
Mailing Address - Fax:
Practice Address - Street 1:1861 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-2303
Practice Address - Country:US
Practice Address - Phone:507-238-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM7302OtherAVERA
MN5T521HAOtherBCBS
MN5T521HAOtherBLUE PLUS
MN39272300Medicaid
MNA011OtherCHAMPUS
MNHP29868OtherHEALTH PARTNERS
MN604587OtherARAZ
MN5T521HAOtherBCBS/MEDICARE SUPPLEMENT
MNMH9041000376OtherPPO
MN01-13394OtherMEDICA
IA959502Medicaid
MN20512OtherSIOUX VALLEY
MN01-13394OtherMEDICA
MNMH9041000376OtherPPO
MNHP29868OtherHEALTH PARTNERS
D75573Medicare UPIN
MN39272300Medicaid