Provider Demographics
NPI:1992753263
Name:HADDAD, HASSAN (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:HADDAD
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 1:8921 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5841
Mailing Address - Country:US
Mailing Address - Phone:918-577-3000
Mailing Address - Fax:
Practice Address - Street 1:8921 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5841
Practice Address - Country:US
Practice Address - Phone:918-577-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25890208M00000X, 207RN0300X, 207RN0300X
MS16965207RN0300X
TXN0814207RN0300X
PAMD054338L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200118650AMedicaid
TN110242767OtherRAILROAD MEDICARE
OK200118650AMedicaid
OK400522582Medicare PIN
TN110242767OtherRAILROAD MEDICARE
TX185865601Medicaid
TN3857778Medicaid
OK200118650AMedicaid
TX00X016Medicare PIN
OK400522582Medicare PIN
MS390000121Medicare PIN
TN4040009OtherBLUE CROSS/ BLUE SHEILD
MS00125931Medicaid
AR145438001Medicaid
TXDG8294Medicare PIN