MEDICARE: DR. MAHMOOD HASSAN MD, PHD

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	207T00000X	Neurological Surgery Physician	27182	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27182	OTHER	AZ	ARIZONA BOARD

General Provider Information

NPI Number	:	1760016471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHMOOD HASSAN MD, PHD

Provider Business Mailing Address
First Line	:	1817 E SOUTHERN AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5814
Country	:	US
Telephone Number	:	520-333-7190
Fax Number	:	520-333-4180

Provider Business Practice Location Address
First Line	:	3935 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1009
Country	:	US
Telephone Number	:	520-333-7190
Fax Number	:	520-333-4180

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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