Basic Information
| Provider Information | |||||||||
| NPI: | 1306248596 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | SCOTT | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2690 | ||||||||
| Address2: | |||||||||
| City: | PINETOP | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859352690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283676688 | ||||||||
| FaxNumber: | 9283674916 | ||||||||
| Practice Location | |||||||||
| Address1: | 728 E WHITE MOUNTAIN BLVD | ||||||||
| Address2: | |||||||||
| City: | PINETOP | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283676688 | ||||||||
| FaxNumber: | 9283674916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2014 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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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 | 363A00000X | 5806 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.