Provider Demographics
NPI:1679284160
Name:NAZAR, DALLAS (PA-C)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:
Last Name:NAZAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SAN PEDRO AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2009
Mailing Address - Country:US
Mailing Address - Phone:210-281-8669
Mailing Address - Fax:
Practice Address - Street 1:4200 SOUTH FWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1407
Practice Address - Country:US
Practice Address - Phone:817-750-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant