Provider Demographics
NPI:1609004233
Name:HASSAN, YUSUF (MD)
Entity Type:Individual
Prefix:
First Name:YUSUF
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:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-771-0304
Mailing Address - Fax:928-778-5742
Practice Address - Street 1:726 GAIL GARDNER WAY
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2314
Practice Address - Country:US
Practice Address - Phone:928-778-0309
Practice Address - Fax:928-778-2678
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44102207RC0000X, 207RI0011X
ARE-13254207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ588914Medicaid
FH2311746OtherDEA
AZ588914Medicaid