Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 37820 | IA |
N | 111NI0900X | Internist | 37820 | IA |
N | 207R00000X | Internist | R7560 | IA |
N | 111NI0900X | Internist | R7560 | IA |
N | 207RC0200X | Critical Care Medicine | 37820 | IA |
Y | 207RP1001X | Pulmonary Disease | 37820 | IA |
NPI | 1043420730 |
---|---|
Provider Name | Boulos S Nassar |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 16/06/2011 |