Healthcare Provider Details

I. General information

NPI: 1386662203
Provider Name (Legal Business Name): PRABHAKARAN K NAMBIAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1253
US

IV. Provider business mailing address

3700 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1253
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-8800
  • Fax: 804-861-0050
Mailing address:
  • Phone: 928-759-8800
  • Fax: 928-443-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number0101038579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: