Provider Demographics
NPI:1003310525
Name:HASAN, SYED MUSTAJAB (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MUSTAJAB
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:RT. 0553
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-762-2328
Mailing Address - Fax:832-632-7866
Practice Address - Street 1:1005 HARBORSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-6500
Practice Address - Country:US
Practice Address - Phone:409-762-2328
Practice Address - Fax:832-632-7866
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10074369207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease