Provider Demographics
NPI:1770562274
Name:HANSEN, RONALD C (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:C
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 1:1919 E THOMAS RD
Mailing Address - Street 2:DERMATOLOGY DEPARTMENT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-933-0895
Mailing Address - Fax:602-933-0628
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:DERMATOLOGY DEPARTMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0895
Practice Address - Fax:602-933-0628
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8283207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69656Medicare UPIN
AZZ156207Medicare PIN