Provider Demographics
NPI:1720065055
Name:HANSON, CARL DWAYNE JR (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DWAYNE
Last Name:HANSON
Suffix:JR
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 1:1601 E 19TH AVE
Mailing Address - Street 2:STE 3450
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1219
Mailing Address - Country:US
Mailing Address - Phone:303-863-1231
Mailing Address - Fax:303-869-2085
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:STE 3450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1219
Practice Address - Country:US
Practice Address - Phone:303-863-1231
Practice Address - Fax:303-869-2085
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27048207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01270487Medicaid
COC38571Medicare PIN
D24891Medicare UPIN