Provider Demographics
NPI:1760016471
Name:HASSAN, MAHMOOD (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5814
Mailing Address - Country:US
Mailing Address - Phone:520-333-7190
Mailing Address - Fax:520-333-4180
Practice Address - Street 1:3935 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1009
Practice Address - Country:US
Practice Address - Phone:520-333-7190
Practice Address - Fax:520-333-4180
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27182207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27182OtherARIZONA BOARD