Healthcare Provider Details

I. General information

NPI: 1306866827
Provider Name (Legal Business Name): KAMIL S NEMRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W. CHEROKEE
LINDSAY OK
73052
US

IV. Provider business mailing address

PO BOX 888
LINDSAY OK
73052-0888
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-1404
  • Fax: 405-756-1476
Mailing address:
  • Phone: 405-756-1404
  • Fax: 405-756-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23221
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM0509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: