Provider Demographics
NPI:1881799989
Name:HANSEN, RALPH S (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:S
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95590
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-5590
Mailing Address - Country:US
Mailing Address - Phone:505-503-8806
Mailing Address - Fax:888-503-8511
Practice Address - Street 1:1524 EUBANK BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4160
Practice Address - Country:US
Practice Address - Phone:505-503-8806
Practice Address - Fax:888-503-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0071208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92228Medicare UPIN