Provider Demographics
NPI:1033129135
Name:NASSAR, ALLAN T (MD)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:T
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 W 4TH ST
Mailing Address - Street 2:BLDING B
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4474
Mailing Address - Country:US
Mailing Address - Phone:559-662-2705
Mailing Address - Fax:559-673-1588
Practice Address - Street 1:1111 W 4TH ST
Practice Address - Street 2:BLDING B
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4474
Practice Address - Country:US
Practice Address - Phone:559-662-2705
Practice Address - Fax:559-673-1588
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068140Medicaid
CALAB13493FMedicaid
CA1699004044Medicaid
CA1699004044Medicare PIN
CAGR0068140Medicaid
ZZZ01107ZMedicare ID - Type Unspecified