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General NPI Number Information
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NPI Number | 1083697205
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Entity Type | Individual
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Provider Name | MUJAHID A NASIR MD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 1311 RING RD STE 101
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8941
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Country | US
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Telephone | 270-900-4555
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Fax | 270-900-4636
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Provider Business Mailing Address
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Address Line | 1321 RING RD STE 105
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8940
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Country | US
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Telephone | 270-986-7373
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Fax | 270-900-4636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39436
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License Number State | KY
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