Provider Demographics
NPI:1447210927
Name:MURSHED, HASAN (MD)
Entity Type:Individual
Prefix:
First Name:HASAN
Middle Name:
Last Name:MURSHED
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 1:2900 S HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5612
Mailing Address - Country:US
Mailing Address - Phone:850-481-1687
Mailing Address - Fax:850-640-0761
Practice Address - Street 1:2900 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5612
Practice Address - Country:US
Practice Address - Phone:850-481-1687
Practice Address - Fax:850-640-0761
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME875232085R0001X
FLTRP2792085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71878OtherBC/BS FLORIDA
FL267670200Medicaid
FL71878OtherBC/BS FLORIDA