1760591689 NPI number — NAHLA D DARKAZALLY MD

Table of content: NAHLA D DARKAZALLY MD (NPI 1760591689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760591689 NPI number — NAHLA D DARKAZALLY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARKAZALLY
Provider First Name:
NAHLA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1760591689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 960160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73196-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-447-2450
Provider Business Mailing Address Fax Number:
405-341-9217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W RANDOL MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-485-4474
Provider Business Practice Location Address Fax Number:
405-844-1794
Provider Enumeration Date:
08/30/2006

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: 207P00000X , with the licence number:  M9157 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 199246302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G57349 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199246303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BT312 . This is a "BCBSTX THRU SAEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BE354 . This is a "BCBSTX THRU AEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00941454 . This is a "RRMCARE THRU SAEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 366474182A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00744176 . This is a "RAILROAD THRU AEMA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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