Healthcare Provider Details

I. General information

NPI: 1205878675
Provider Name (Legal Business Name): MOHAMMAD ABOUS SABUR-NASIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 SANDHURST DR
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

508 SANDHURST DR
FAYETTEVILLE NC
28304
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-0900
  • Fax: 910-485-0080
Mailing address:
  • Phone: 910-485-0900
  • Fax: 910-485-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35740
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: