Provider Demographics
NPI:1871013938
Name:HANSEN, DWAYNE MAXWELL JR (DO)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:MAXWELL
Last Name:HANSEN
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1301 N. COLUMBIA RD STOP 9037
Mailing Address - Street 2:UND DEPARTMENT OF SURGERY
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9037
Mailing Address - Country:US
Mailing Address - Phone:701-777-3067
Mailing Address - Fax:
Practice Address - Street 1:1301 N COLUMBIA RD STOP 9037
Practice Address - Street 2:UND DEPARTMENT OF SURGERY
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9037
Practice Address - Country:US
Practice Address - Phone:701-777-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-04-28
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Provider Licenses
StateLicense IDTaxonomies
IDO-1663208600000X
NDRL14661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery