Provider Demographics
NPI:1679545560
Name:DAHSHAN, AHMED HASSAN (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:HASSAN
Last Name:DAHSHAN
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2230
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5300 E ERICKSON DR STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2828
Practice Address - Country:US
Practice Address - Phone:520-324-7200
Practice Address - Fax:520-324-7201
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ556912080P0206X
WV244182080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100058610CMedicaid
WV3810020800Medicaid
AZ355895Medicaid
OK241411005Medicare ID - Type Unspecified
WV3810020800Medicaid