Provider Demographics
NPI:1811934847
Name:HANSEN, JAMES G (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
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 1:1200 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2395
Mailing Address - Country:US
Mailing Address - Phone:406-363-2211
Mailing Address - Fax:406-363-6536
Practice Address - Street 1:1200 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2395
Practice Address - Country:US
Practice Address - Phone:406-363-2211
Practice Address - Fax:406-363-6536
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3808207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0352066Medicaid
MT000081386Medicare ID - Type UnspecifiedMDMH CONVENIENT CARE
MT0352066Medicaid
E41127Medicare UPIN