Healthcare Provider Details

I. General information

NPI: 1306839196
Provider Name (Legal Business Name): ABDUL NAUSHAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 JAMES BLVD
POPLAR BLUFF MO
63901-2803
US

IV. Provider business mailing address

622 COLLINS DR STE. 200
FESTUS MO
63028-2077
US

V. Phone/Fax

Practice location:
  • Phone: 636-638-1506
  • Fax: 636-638-1507
Mailing address:
  • Phone: 636-638-1506
  • Fax: 636-638-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL N NAUSHAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 636-638-1506