Healthcare Provider Details

I. General information

NPI: 1063836765
Provider Name (Legal Business Name): MOHAMED HASSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2014
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5569 GROVE BLVD
HOOVER AL
35226
US

IV. Provider business mailing address

121 BUMPER CROP LN NW
MADISON AL
35757-6963
US

V. Phone/Fax

Practice location:
  • Phone: 205-637-2600
  • Fax:
Mailing address:
  • Phone: 813-328-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.35658
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD35658
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: