MEDICARE: LOUAY K NASSRI 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	208000000X	Pediatrics Physician	R2933	AR

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	:	1881681799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUAY K NASSRI MD

Provider Business Mailing Address
First Line	:	PO BOX 10718
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0718
Country	:	US
Telephone Number	:	479-221-3732
Fax Number	:	479-649-8275

Provider Business Practice Location Address
First Line	:	9207 HIGHWAY 71 S
Second Line	:	STE 9
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9117
Country	:	US
Telephone Number	:	479-434-6140
Fax Number	:	479-434-6144

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/02/2016

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Directions to “ LOUAY K NASSRI MD” Practice Location

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