Provider Demographics
NPI:1023073210
Name:HANSEN, WINFRIED H (MD)
Entity type:Individual
Prefix:
First Name:WINFRIED
Middle Name:H
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 1:2020 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8145
Mailing Address - Country:US
Mailing Address - Phone:850-476-8467
Mailing Address - Fax:850-476-8468
Practice Address - Street 1:2020 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8145
Practice Address - Country:US
Practice Address - Phone:850-476-8467
Practice Address - Fax:850-476-8468
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24683207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17297OtherBLUE CROSS BLUE SHIELD
AL590-20227OtherBLUE CROSS BLUE SHIELD
183572197OtherMEDICARE RAILROAD
FL054068400Medicaid
AL009946810Medicaid
FL17297ZMedicare PIN
C04149Medicare UPIN