Healthcare Provider Details

I. General information

NPI: 1912072604
Provider Name (Legal Business Name): ELIAS N NASR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL SUITE 400
SIERRA VISTA AZ
85635-2900
US

IV. Provider business mailing address

302 EL CAMINO REAL STE 5
SIERRA VISTA AZ
85635-2860
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-0229
  • Fax: 520-458-1038
Mailing address:
  • Phone: 520-458-4335
  • Fax: 520-452-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36124
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number36124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: