Provider Demographics
NPI:1396852216
Name:HASEN, HOWARD BERNHARD JR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:BERNHARD
Last Name:HASEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3400
Mailing Address - Fax:901-384-8840
Practice Address - Street 1:1325 WOLF PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1742
Practice Address - Country:US
Practice Address - Phone:901-252-3400
Practice Address - Fax:901-384-8840
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD009042208800000X
AR2888208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4024943OtherAETNA
AR52222B313OtherARK CARE
2585821OtherCIGNA
4139069OtherBLUE CROSS TN
52222OtherBLUE CROSS AR
AR52222B313OtherARK CARE
TN3178674Medicare ID - Type Unspecified
52222OtherBLUE CROSS AR
C68456Medicare UPIN