Healthcare Provider Details

I. General information

NPI: 1972682219
Provider Name (Legal Business Name): HASSAN H GHAZAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SUITE 3-O
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR SUITE 3-O
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2239
  • Fax: 606-439-3096
Mailing address:
  • Phone: 606-439-2239
  • Fax: 606-439-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number000033691
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: