Healthcare Provider Details

I. General information

NPI: 1326041203
Provider Name (Legal Business Name): DAVID R. HASSELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

PO BOX 91119
MOBILE AL
36691-1119
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-0326
  • Fax: 251-460-2846
Mailing address:
  • Phone: 251-460-0326
  • Fax: 251-460-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13276
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: