Individual
MUTASIM N. ABU-HASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-8379
(352) 392-4450
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 273-8379
(352) 392-4450
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
33418
IA
2080P0214X
Pediatric Pulmonology Physician
04-33202
KS
2080P0214X
Pediatric Pulmonology Physician
33418
IA
2080P0214X
Pediatric Pulmonology Physician
Primary
ME107986
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002981400
—
FL
05
—
0212985
—
IA
01
—
17554
WELLMARK BCBS
IA
Enumeration date
09/16/2005
Last updated
02/08/2011
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