MEDICARE: DR. BASSAM S NAKFOUR 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	207V00000X	Obstetrics & Gynecology Physician	39302	OH

General Provider Information

NPI Number	:	1811126956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASSAM S NAKFOUR MD

Provider Business Mailing Address
First Line	:	809 BLOSSOM HEATH RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1102
Country	:	US
Telephone Number	:	937-294-3217
Fax Number	:	937-293-6002

Provider Business Practice Location Address
First Line	:	809 BLOSSOM HEATH RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1102
Country	:	US
Telephone Number	:	937-294-3217
Fax Number	:	937-293-6002

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

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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