Provider Demographics
NPI:1679806947
Name:NAZIR BALOUCH MD PC
Entity type:Organization
Organization Name:NAZIR BALOUCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-307-1000
Mailing Address - Street 1:401 W MAIN ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1319
Mailing Address - Country:US
Mailing Address - Phone:405-364-3040
Mailing Address - Fax:405-307-0883
Practice Address - Street 1:901 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6404
Practice Address - Country:US
Practice Address - Phone:405-307-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200219350AMedicaid