Provider Demographics
NPI:1396777876
Name:HASSIN, IAN BRUCE (DO)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:BRUCE
Last Name:HASSIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:IAN
Other - Middle Name:B
Other - Last Name:HASSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3220 DAYBREAKER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5838
Mailing Address - Country:US
Mailing Address - Phone:561-389-1518
Mailing Address - Fax:435-615-7316
Practice Address - Street 1:3220 DAYBREAKER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5838
Practice Address - Country:US
Practice Address - Phone:561-389-1518
Practice Address - Fax:435-615-7316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV91085207Q00000X
UT7686635-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27315Medicare UPIN