Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | BP10074369 | TX |
NPI | 1003310525 |
---|---|
Provider Name | Syed Mustajab Hasan |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 06/07/2021 |