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General NPI Number Information
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NPI Number | 1659325165
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Entity Type | Individual
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Provider Name | ISSAM RAFIC NASR MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 2815
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-586-1850
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Fax | 386-586-1850
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Provider Business Mailing Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 2815
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-586-1810
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Fax | 386-586-1811
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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 | 36550
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0109365
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License Number State | FL
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