Provider Demographics
NPI:1770522633
Name:ALISSA, HASSAN M (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:M
Last Name:ALISSA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1340 WONDER WORLD DR
Mailing Address - Street 2:BLDG.2, SUITE 2203
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7598
Mailing Address - Country:US
Mailing Address - Phone:512-667-7123
Mailing Address - Fax:512-667-7328
Practice Address - Street 1:1340 WONDER WORLD DR
Practice Address - Street 2:BLDG.2, SUITE 2203
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7598
Practice Address - Country:US
Practice Address - Phone:512-667-7123
Practice Address - Fax:512-667-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000160315207RR0500X
TXM7820207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
152268OtherBCBS
MO205333818Medicaid
P00152821OtherRAILROAD MEDICARE
P00152821OtherRAILROAD MEDICARE
MO205333818Medicaid