Healthcare Provider Details

I. General information

NPI: 1659562627
Provider Name (Legal Business Name): NAQI IDRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 I 30 STE 220
MESQUITE TX
75150-2601
US

IV. Provider business mailing address

1505 LBJ FWY STE 700
DALLAS TX
75234-6065
US

V. Phone/Fax

Practice location:
  • Phone: 214-358-2300
  • Fax: 214-579-6994
Mailing address:
  • Phone: 214-358-2300
  • Fax: 214-579-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM7287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: