Healthcare Provider Details

I. General information

NPI: 1952531121
Provider Name (Legal Business Name): SHERIF NASEF, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 AIRWAY AVE
KINGMAN AZ
86409-3620
US

IV. Provider business mailing address

1755 AIRWAY AVE
KINGMAN AZ
86409-3620
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-1234
  • Fax: 928-681-1811
Mailing address:
  • Phone: 928-681-1234
  • Fax: 928-681-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number27906
License Number StateAZ

VIII. Authorized Official

Name: DR. SHERIF NASEF
Title or Position: OWNER
Credential: M.D.
Phone: 928-279-6503