MEDICARE: DR. ELIAS HASBUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME 32759	FL

General Provider Information

NPI Number	:	1225158934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIAS HASBUN M.D.

Provider Business Mailing Address
First Line	:	1263 JUNGLE AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-4329
Country	:	US
Telephone Number	:	727-347-5424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1263 JUNGLE AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-4329
Country	:	US
Telephone Number	:	727-347-5424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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