| Entity Name: | RAYMOND D. HANSEN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 17 Feb 1981 (44 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Apr 2020 (5 years ago) |
| Document Number: | F20073 |
| FEI/EIN Number | 59-2080540 |
| Address: | 1972 BAYSHORE BLVD., DUNEDIN, FL 34698 |
| Mail Address: | 1972 BAYSHORE BLVD., DUNEDIN, FL 34698 |
| ZIP code: | 34698 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265620520 | 2007-10-11 | 2022-07-21 | 1972 BAYSHORE BLVD, DUNEDIN, FL, 346982577, US | 1972 BAYSHORE BLVD, DUNEDIN, FL, 346982577, US | |||||||||||||||||||||||
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| Phone | +1 727-736-2513 |
| Fax | 7277344701 |
Authorized person
| Name | DR. RAYMOND. DANIEL HANSEN |
| Role | OWNER |
| Phone | 7277362513 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 052445000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Raymond D Hansen MD PA | Agent | 2280 RANCHETTE LANE, DUNEDIN, FL 34698 |
| Name | Role | Address |
|---|---|---|
| HANSEN, RAYMOND D. | President | 1972 BAYSHORE BLVD., DUNEDIN, FL |
| Name | Role | Address |
|---|---|---|
| HANSEN, RAYMOND DIII | Vice President | 1972 BAY SHORE BLVD, DUNEDIN, FL 34698 |
| Name | Role | Address |
|---|---|---|
| Hansen, Mahi H | Treasurer | 1972 Bayshore Blvd, Dunedin, FL 34698 |
| Name | Role | Address |
|---|---|---|
| Hansen, Mahi H | Secretary | 1972 Bayshore Blvd, Dunedin, FL 34698 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2020-04-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-04-01 | Raymond D Hansen MD PA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-11 | 2280 RANCHETTE LANE, DUNEDIN, FL 34698 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1988-02-17 | 1972 BAYSHORE BLVD., DUNEDIN, FL 34698 | No data |
| CHANGE OF MAILING ADDRESS | 1988-02-17 | 1972 BAYSHORE BLVD., DUNEDIN, FL 34698 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-28 |
| REINSTATEMENT | 2020-04-01 |
| ANNUAL REPORT | 2015-01-14 |
| ANNUAL REPORT | 2014-06-10 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-04-03 |
| ANNUAL REPORT | 2011-01-11 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
