Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD61092467 | WA |
N | 111NI0900X | Internist | MD61092467 | WA |
N | 207RH0000X | Hematologist | MD61092467 | WA |
N | 207RH0003X | Hematology & Oncology | L2619 | TX |
N | 207RH0003X | Hematology & Oncology | TD61092468 | WA |
Y | 207RX0202X | Medical Oncology | MD61092467 | WA |
NPI | 1164420105 |
---|---|
Provider Name | Mohammed Hassan Sabbagh |
First Address | Vancouver, WA 98683-8004 |
Second Address | Sedro Woolley, WA 98284-4327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144386302 | (05) | TX |
8084N0 | BCBS (01) | TX |