Healthcare Provider Details

I. General information

NPI: 1104131820
Provider Name (Legal Business Name): WILLIAM NASSOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 W MCDOWELL RD STE 205
GOODYEAR AZ
85395-2626
US

IV. Provider business mailing address

13555 WEST MCDOWELL RD. STE. 205
GOODYEAR AZ
85395-2626
US

V. Phone/Fax

Practice location:
  • Phone: 623-295-1190
  • Fax: 602-429-8595
Mailing address:
  • Phone: 623-295-1190
  • Fax: 602-429-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47483
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47483
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: