=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447681390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUDASSIR NAWAZ, M.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2013
-----------------------------------------------------
Last Update Date | 12/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E ROBINSON ST SUITE 800
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-1004
-----------------------------------------------------
Fax | 405-321-1074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 E ROBINSON ST SUITE 800
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-6697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-321-1004
-----------------------------------------------------
Fax | 405-321-1074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MUDASSIR NAWAZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-321-1004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 24893
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------