Basic Information
| Provider Information | |||||||||
| NPI: | 1376835157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASSER | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | MUNZER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | STE 205 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51446 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 51446 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 095137 | 05 | AZ | MEDICAID |