Provider Demographics
NPI:1235212192
Name:HANSEN, SCOTT F (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:F
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-8700
Mailing Address - Fax:801-408-8732
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-8700
Practice Address - Fax:801-408-8732
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1608301205207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057012Medicaid
UT000062188Medicare PIN
UT000063292Medicare PIN
UTE04591Medicare UPIN
UT000060362Medicare PIN