MEDICARE: DR. YARA D NAZZAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	2015029486	MO
2	2084N0400X	Neurology Physician	T9019	TX
3	2084N0400X	Neurology Physician	036152305	IL
4	2084N0400X	Neurology Physician	MD215253	OR
5	2084N0400X	Neurology Physician	04-42165	KS
6	2084N0400X	Neurology Physician	38049	OK
7	2084N0400X	Neurology Physician	33054	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477845584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YARA D NAZZAL MD

Provider Business Mailing Address
First Line	:	PO BOX 3777
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3777
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19260 SW 65TH AVE STE 280
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-5708
Country	:	US
Telephone Number	:	503-413-6166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2011
Last Update Date	:	07/19/2024

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Directions to “ DR. YARA D NAZZAL MD” Practice Location

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