Individual
MOHAMMAD R HASSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2000 W 21ST ST, W7, CLOVIS, NM 88101-4087
(575) 763-3666
(575) 762-3520
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20030757
NM
207RC0000X
Cardiovascular Disease Physician
L3891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153906603
—
TX
05
—
23371340
—
NM
01
—
348431307
MEDICARE
NM
01
—
TXB123657
MEDICARE
TX
Enumeration date
04/14/2006
Last updated
06/10/2019
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