Dwayne M. Hansen MD Pllc

NPI #1114024650 in Rexburg, Idaho

Provider Information

NPI Number
1114024650
Entity Type
Organization
Organization Name
Dwayne M. Hansen MD Pllc
Primary Specialty
Surgery
Enumeration Date
Sep 19, 2006
Last Updated
Dec 6, 2007

Practice Location

Address
381 EAST 4TH NORTH STREET
Address 2
SUITE 100
State
Idaho
ZIP Code
83440
Phone
(208) 656-8442

Authorized Official

Name
MR. DWAYNE M. HANSEN, MD
Title
OWNER
Phone
(208) 656-8442

Specialties & Taxonomy Codes

Specialty
Surgery

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Provider Name
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