Hanson, Glen Ray
Hanson, Glen Ray is an individual health care provider with primary practice located at 3315 Kethley Rd , Shawnee OK 74804-9638. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Hanson, Glen Ray can be contacted via phone (405) 273-5801.Contact Information
Primary practice address
3315 Kethley Rd
Shawnee OK 74804-9638
Phone: (405) 273-5801
Fax: (405) 878-3814
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 18843 | Oklahoma |
Profile Details
| NPI number | 1497795652 |
|---|---|
| LBN Legal business name | Hanson, Glen Ray |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 7th, 2006 |
| Last updated | Aug 29th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497795652 | NPPES |
| Oklahoma | MEDICAID | 100094710A |
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