Provider Demographics
NPI:1245284587
Name:HANSEN, H. WAYNE (MD)
Entity type:Individual
Prefix:
First Name:H.
Middle Name:WAYNE
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 1:2601 N 3RD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1104
Mailing Address - Country:US
Mailing Address - Phone:602-234-2601
Mailing Address - Fax:602-234-3183
Practice Address - Street 1:2601 N 3RD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1104
Practice Address - Country:US
Practice Address - Phone:602-234-2601
Practice Address - Fax:602-234-3183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ168802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z30WCHBR02Medicare ID - Type Unspecified
AZE00220Medicare UPIN