Provider Demographics
NPI:1265620520
Name:RAYMOND D.HANSEN M D P.A
Entity type:Organization
Organization Name:RAYMOND D.HANSEN M D P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND.
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-736-2513
Mailing Address - Street 1:1972 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2577
Mailing Address - Country:US
Mailing Address - Phone:727-736-2513
Mailing Address - Fax:727-734-4701
Practice Address - Street 1:1972 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2577
Practice Address - Country:US
Practice Address - Phone:727-736-2513
Practice Address - Fax:727-734-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052445000Medicaid
FL052445000Medicaid
FLK1927Medicare PIN