1235579293 NPI number — DR. KHALID GAMAL ABOUL-NASR M.D.

Table of content: DR. KHALID GAMAL ABOUL-NASR M.D. (NPI 1235579293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235579293 NPI number — DR. KHALID GAMAL ABOUL-NASR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABOUL-NASR
Provider First Name:
KHALID
Provider Middle Name:
GAMAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235579293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1255 W WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-685-5211
Provider Business Mailing Address Fax Number:
602-685-5325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 N WILMOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-685-5211
Provider Business Practice Location Address Fax Number:
602-685-5325
Provider Enumeration Date:
07/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  53563 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZC0500X , with the licence number: 53563 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 458765 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53563 . This is a "ARIZONA MEDICAL LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".