Provider Demographics
NPI:1659174266
Name:HASAN, MD RAJIBUL
Entity type:Individual
Prefix:
First Name:MD
Middle Name:RAJIBUL
Last Name:HASAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3214 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4810
Mailing Address - Country:US
Mailing Address - Phone:501-380-2280
Mailing Address - Fax:501-380-2282
Practice Address - Street 1:3214 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4810
Practice Address - Country:US
Practice Address - Phone:501-380-2280
Practice Address - Fax:501-380-2282
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program