Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | J6480 | TX |
N | 111NI0900X | Internist | J6480 | TX |
N | 207RH0002X | Hospice and Palliative Medicine | J6480 | TX |
Y | 207RI0200X | Infectious Disease | J6480 | TX |
NPI | 1255369815 |
---|---|
Provider Name | Dr. Mirza Shahbaz Hasan |
First Address | Dallas, TX 75231-4407 |
Second Address | Dallas, TX 75231-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 13/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101889703 | (05) | TX |
101889705 | (05) | TX |
101889706 | (05) | TX |
8B5309 | BCBS (01) | TN |
G51156 | (02) | |
P00250019 | RR MEDICARE (01) | TX |