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General NPI Number Information
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NPI Number | 1437175056
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Entity Type | Individual
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Provider Name | AEJAZ NASIR MBBS
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 11505 PALMBRUSH TRL STE 120
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2915
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Country | US
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Telephone | 941-757-4800
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Fax | 941-757-4803
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Provider Business Mailing Address
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Address Line | 11505 PALMBRUSH TRL STE 120
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-2915
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Country | US
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Telephone | 941-757-4800
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Fax | 941-757-4803
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | ME147477
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License Number State | FL
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