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General NPI Number Information
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NPI Number | 1245404144
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Entity Type | Organization
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Legal Business Name | GHASSAN HASAN MD PA
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD SUITE 416
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1015
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Country | US
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Telephone | 954-392-8990
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Fax | 954-392-8909
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Provider Business Mailing Address
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Address Line | 14510 SW 35TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-3748
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Country | US
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Telephone | 305-803-8097
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Fax | 954-441-1403
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Authorized Official
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Title or Position | PRESIDENT
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Name | GHASSAN A HASAN
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Credential | MD
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Telephone | 305-803-8097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 94778
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License Number State | FL
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