Individual
ANUM MALLICK HASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 HENDERSON ST, APT 330, FORT WORTH, TX 76102
(302) 562-5246
Mailing address
1000 HENDERSON ST, APT 330, FORT WORTH, TX 76102
(302) 562-5246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10087
TX
363AM0700X
Medical Physician Assistant
C0005122
MD
Other
Enumeration date
03/16/2010
Last updated
05/03/2016
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