Basic Information
| Provider Information | |||||||||
| NPI: | 1790735579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASSAR | ||||||||
| FirstName: | RAMZI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2440 E TUDOR RD | ||||||||
| Address2: | PMB 1145 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995071185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075620001 | ||||||||
| FaxNumber: | 9075620017 | ||||||||
| Practice Location | |||||||||
| Address1: | 4048 LAUREL ST | ||||||||
| Address2: | STE 305 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075620001 | ||||||||
| FaxNumber: | 9075620017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 3522 | AK | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | MD22531 | 05 | AK | MEDICAID |