Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0201X | Pediatric Allergist | 33418 | IA |
N | 2080P0214X | Pediatric Pulmonologist | 04-33202 | KS |
N | 2080P0214X | Pediatric Pulmonologist | 33418 | IA |
Y | 2080P0214X | Pediatric Pulmonologist | ME107986 | FL |
NPI | 1558356402 |
---|---|
Provider Name | Mutasim N. Abu-Hasan |
First Address | Orlando, FL 32891-8025 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 08/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002981400 | (05) | FL |
0212985 | (05) | IA |
17554 | WELLMARK BCBS (01) | IA |
H12268 | (02) |