Provider Demographics
NPI:1568579308
Name:HASSOUN, BASEL S (MD)
Entity Type:Individual
Prefix:
First Name:BASEL
Middle Name:S
Last Name:HASSOUN
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 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8359
Mailing Address - Country:US
Mailing Address - Phone:405-749-9889
Mailing Address - Fax:405-755-1166
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 501
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8359
Practice Address - Country:US
Practice Address - Phone:405-749-9889
Practice Address - Fax:405-755-1166
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18282208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100042740AMedicaid
OK100042740AMedicaid
OK$$$$$$$$$004OtherBCBS
OKF46786Medicare UPIN
OK5390430011Medicare NSC
OK100042740AMedicaid