Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | S7228 | TX |
NPI | 1003311093 |
---|---|
Provider Name | Mazen Hassan |
First Address | Dallas, TX 75246-1905 |
Second Address | Dallas, TX 75246-1905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 10/10/2021 |