Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | K5990 | TX |
NPI | 1003841982 |
---|---|
Provider Name | Aziza Q Hasan |
First Address | Houston, TX 77216-1088 |
Second Address | Baytown, TX 77520-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 19/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86655J | BCBS (01) | TX |
G77884 | (02) | TX |