Provider Demographics
NPI:1053495267
Name:NASSAR, EDDIE RICHARD (MD,)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:RICHARD
Last Name:NASSAR
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 DONIPHAN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932
Mailing Address - Country:US
Mailing Address - Phone:915-881-4225
Mailing Address - Fax:915-881-4197
Practice Address - Street 1:5000 DONIPHAN
Practice Address - Street 2:SUITE 104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932
Practice Address - Country:US
Practice Address - Phone:915-881-4225
Practice Address - Fax:915-881-4197
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5482208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL5482OtherPHYSICIAN PERMIT