Individual ProviderTimothy Keith HansonPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansPractice Address3181 SW Sam Jackson Park Rd, Ohsu, Portland, OR 97239-3011(503) 494-8211(503) 319-9942PECOS EnrollmentBased on the most recent information from CMS, provider Timothy Keith Hanson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1588930051Provider TypeIndividualFull NameHanson, Timothy KeithCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date3/28/2012Last Updated8/4/2015Contact InformationPractice LocationPractice Address3181 SW Sam Jackson Park Rd, Ohsu, Portland, OR 97239-3011Phone(503) 494-8211FaxUnlisted FaxMailing LocationMailing Address912 SW Vista Ave, Apt 204, Portland, OR 97205Phone(503) 319-9942FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2084P0800XPrimaryDescriptionPsychiatry & NeurologyAllopathic & Osteopathic PhysiciansLicenseMD171787OregonCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer