Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 301986 | NY |
NPI | 1063825768 |
---|---|
Provider Name | Samir Hasan |
First Address | Saint Louis, MO 63108-2200 |
Second Address | Saint Louis, MO 63110-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 07/05/2021 |