Provider Demographics
NPI:1477004935
Name:PEDIATRIC ADULT ENDOCRINE GILBERT
Entity Type:Organization
Organization Name:PEDIATRIC ADULT ENDOCRINE GILBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-821-2883
Mailing Address - Street 1:2730 S VAL VISTA DR
Mailing Address - Street 2:BLDG 10, SUITE 161
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1675
Mailing Address - Country:US
Mailing Address - Phone:480-821-2883
Mailing Address - Fax:480-237-5799
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:BLDG 10, SUITE 161
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-821-2883
Practice Address - Fax:480-237-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty