Basic Information
| Provider Information | |||||||||
| NPI: | 1477566016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASAN | ||||||||
| FirstName: | MOSAAB | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 499 10TH ST. | ||||||||
| Address2: | |||||||||
| City: | FLORESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931300 | ||||||||
| FaxNumber: | 8303931301 | ||||||||
| Practice Location | |||||||||
| Address1: | 497 10TH ST. STE. 105 | ||||||||
| Address2: | |||||||||
| City: | FLORESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303931363 | ||||||||
| FaxNumber: | 8303931366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 02/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 01070750A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | K6792 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 201068010 | 05 | IN | MEDICAID |