Basic Information
| Provider Information | |||||||||
| NPI: | 1013957752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11529 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989092428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153933000 | ||||||||
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| Practice Location | |||||||||
| Address1: | SAINT CLARE'S HOSPITAL-DEPT. OF ANESTHESIOLOGY | ||||||||
| Address2: | 3400 MINISTRY PARKWAY | ||||||||
| City: | WESTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153933000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD60833231 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 48083 | WI | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 34691000 | 05 | WI | MEDICAID |