Provider Demographics
NPI:1407805989
Name:HASSAN, A SAMIR (MD)
Entity type:Individual
Prefix:DR
First Name:A
Middle Name:SAMIR
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:201 4TH AVE E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1043
Mailing Address - Country:US
Mailing Address - Phone:941-748-6099
Mailing Address - Fax:941-747-5061
Practice Address - Street 1:201 4TH AVE E
Practice Address - Street 2:SUITE 2
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1043
Practice Address - Country:US
Practice Address - Phone:941-748-6099
Practice Address - Fax:941-747-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066896600Medicaid
FL408023104OtherRAILRODA MEDICARE FLORIDA
FLD86361Medicare UPIN
FL066896600Medicaid