Healthcare Provider Details

I. General information

NPI: 1922028513
Provider Name (Legal Business Name): NAZAR A NOORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E VAN BUREN ST
PHOENIX AZ
85006
US

IV. Provider business mailing address

PO BOX 86459
PHOENIX AZ
85080
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-8316
  • Fax: 480-333-5165
Mailing address:
  • Phone: 602-251-8316
  • Fax: 480-333-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK7071
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35685
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35685
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: