=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932136009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHALIL A HASAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 10/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 SW 34TH AVE SUITE 202A
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-7456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-622-7188
-----------------------------------------------------
Fax | 352-622-9861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 SW 34TH AVE SUITE 202A
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-7456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-622-7188
-----------------------------------------------------
Fax | 352-622-9861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME43392
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------