Provider Demographics
NPI:1407169113
Name:HASSAN, SOHAIB (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIB
Middle Name:
Last Name:HASSAN
Suffix:
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 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 4.234
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:216-533-8684
Mailing Address - Fax:
Practice Address - Street 1:410 CELEBRATION PL STE 106
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5432
Practice Address - Country:US
Practice Address - Phone:407-303-4829
Practice Address - Fax:407-303-4851
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4975207RG0100X
FLME146942207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107956600Medicaid