Basic Information
| Provider Information | |||||||||
| NPI: | 1437183928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSPETERSEN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10030 SW 210TH ST | ||||||||
| Address2: | |||||||||
| City: | VASHON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980706584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064633671 | ||||||||
| FaxNumber: | 2064633613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00043102 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 13547 | 01 | FL | BC | OTHER | ME92602 | 01 | FL | MEDICAL LICENSE | OTHER | 271956800 | 05 | FL | MEDICAID |