Provider Demographics
NPI:1477566016
Name:HASAN, MOSAAB A (MD)
Entity Type:Individual
Prefix:
First Name:MOSAAB
Middle Name:A
Last Name:HASAN
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 1:499 10TH ST.
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114
Mailing Address - Country:US
Mailing Address - Phone:830-393-1300
Mailing Address - Fax:830-393-1301
Practice Address - Street 1:497 10TH ST. STE. 105
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114
Practice Address - Country:US
Practice Address - Phone:830-393-1363
Practice Address - Fax:830-393-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070750A207RG0100X
TXK6792207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201068010Medicaid
TX8F7994Medicare PIN
IN201068010Medicaid