Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 15162 | NV |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 15162 | NV |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 15162 | NV |
NPI | 1215290499 |
---|---|
Provider Name | Dr. Nazar E Mohamed Sanousi |
First Address | Reno, NV 89502-1576 |
Second Address | Reno, NV 89502-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215290499 | (05) | NV |
12682258 | CAQH (01) | |
P01587694 | RAILROAD MEDICARE (01) | NV |