Provider Demographics
NPI:1528327905
Name:HASSELL, JONATHAN MARK (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARK
Last Name:HASSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 N JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-1776
Mailing Address - Country:US
Mailing Address - Phone:936-637-1342
Mailing Address - Fax:
Practice Address - Street 1:2206 N JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1776
Practice Address - Country:US
Practice Address - Phone:936-637-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-06
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4765207R00000X
KYR2939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine