Provider Demographics
NPI:1033159140
Name:AZAR, NABIL (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:
Last Name:AZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NABIL
Other - Middle Name:
Other - Last Name:AZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-575-1400
Mailing Address - Fax:228-575-1414
Practice Address - Street 1:1340 BROAD AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2418
Practice Address - Country:US
Practice Address - Phone:228-575-1400
Practice Address - Fax:228-575-1414
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14521207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115228Medicaid
MS$$$$$$$$$COtherBCBS
MS110107965Medicare PIN
MS$$$$$$$$$COtherBCBS
MS00115228Medicaid
MSG11277Medicare UPIN
MS512I110235Medicare PIN