Healthcare Provider Details

I. General information

NPI: 1053495267
Provider Name (Legal Business Name): EDDIE RICHARD NASSAR M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 DONIPHAN SUITE 104
EL PASO TX
79932
US

IV. Provider business mailing address

5000 DONIPHAN SUITE 104
EL PASO TX
79932
US

V. Phone/Fax

Practice location:
  • Phone: 915-881-4225
  • Fax: 915-881-4197
Mailing address:
  • Phone: 915-881-4225
  • Fax: 915-881-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: