Provider Demographics
NPI:1053514661
Name:NASR, OSMAN KHALID
Entity type:Individual
Prefix:MR
First Name:OSMAN
Middle Name:KHALID
Last Name:NASR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 E MCDOWELL RD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4202
Mailing Address - Country:US
Mailing Address - Phone:602-651-1430
Mailing Address - Fax:602-354-5960
Practice Address - Street 1:4914 E MCDOWELL RD
Practice Address - Street 2:SUITE # 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4202
Practice Address - Country:US
Practice Address - Phone:602-651-1430
Practice Address - Fax:602-354-5960
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ042031343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042031OtherTRANSPORTATION