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General NPI Number Information
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NPI Number | 1285086868
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Entity Type | Individual
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Provider Name | SYED MOJIZ UL HASAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1350 US HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4124
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Country | US
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Telephone | 636-931-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 US HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4124
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Country | US
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Telephone | 636-931-3655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 2019024553
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2019024553
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License Number State | MO
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