Healthcare Provider Details

I. General information

NPI: 1477566016
Provider Name (Legal Business Name): MOSAAB A. HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 10TH ST. STE. 105
FLORESVILLE TX
78114
US

IV. Provider business mailing address

499 10TH ST.
FLORESVILLE TX
78114
US

V. Phone/Fax

Practice location:
  • Phone: 830-393-1363
  • Fax: 830-393-1366
Mailing address:
  • Phone: 830-393-1300
  • Fax: 830-393-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01070750A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberK6792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: