Healthcare Provider Details

I. General information

NPI: 1750497756
Provider Name (Legal Business Name): JOHN A. NASSAR, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 N. VIA DE NEGOCIO DR.
SCOTTSDALE AZ
85258-2312
US

IV. Provider business mailing address

9393 N 90TH ST SUITE 102-126
SCOTTSDALE AZ
85258-5040
US

V. Phone/Fax

Practice location:
  • Phone: 480-451-3668
  • Fax:
Mailing address:
  • Phone: 480-451-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number28964
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN A. NASSAR
Title or Position: OFFICER/OWNER
Credential: M.D.
Phone: 480-451-3668