=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790895035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED S HASAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 02/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-1703
-----------------------------------------------------
Fax | 352-666-1366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 MARINER BLVD
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-1703
-----------------------------------------------------
Fax | 352-666-1366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME75485
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | FL-ME75485-A
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------