Basic Information
| Provider Information | |||||||||
| NPI: | 1790149219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARLAN HANSEN MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95590 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840950590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013527976 | ||||||||
| Practice Location | |||||||||
| Address1: | 538 S 500 E | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016422000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | GORES | ||||||||
| AuthorizedOfficialFirstName: | KAILEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8013529500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 327162-1205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.