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General NPI Number Information
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NPI Number | 1316911092
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Entity Type | Individual
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Provider Name | ASIF NISAR MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 300 18TH STREET SUITE 200
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5874
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Country | US
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Telephone | 337-439-5369
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Fax | 337-436-9998
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Provider Business Mailing Address
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Address Line | 300 18TH STREET SUITE 200
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5874
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Country | US
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Telephone | 337-439-5369
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Fax | 337-436-9998
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA72826
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MA72826
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD.203470
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License Number State | LA
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