Healthcare Provider Details

I. General information

NPI: 1881681799
Provider Name (Legal Business Name): LOUAY K NASSRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9207 HIGHWAY 71 S STE 9
FORT SMITH AR
72916-9117
US

IV. Provider business mailing address

PO BOX 10718
FORT SMITH AR
72917-0718
US

V. Phone/Fax

Practice location:
  • Phone: 479-434-6140
  • Fax: 479-434-6144
Mailing address:
  • Phone: 479-221-3732
  • Fax: 479-649-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2933
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: