MEDICARE: ISSAM RAFIC NASR 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	207R00000X	Internal Medicine Physician	36550	IA
2	207RG0100X	Gastroenterology Physician	ME0109365	FL

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	25320	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1659325165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISSAM RAFIC NASR MD

Provider Business Mailing Address
First Line	:	61 MEMORIAL MEDICAL PKWY
Second Line	:	SUITE 2815
City	:	PALM COAST
State	:	FL
Zip	:	32164-5981
Country	:	US
Telephone Number	:	386-586-1810
Fax Number	:	386-586-1811

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY
Second Line	:	SUITE 2815
City	:	PALM COAST
State	:	FL
Zip	:	32164-5981
Country	:	US
Telephone Number	:	386-586-1850
Fax Number	:	386-586-1850

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/17/2020

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Directions to “ ISSAM RAFIC NASR MD” Practice Location

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