Provider Demographics
NPI:1063450518
Name:SOGHRATI, NASER O (DO)
Entity Type:Individual
Prefix:DR
First Name:NASER
Middle Name:O
Last Name:SOGHRATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-0040
Mailing Address - Country:US
Mailing Address - Phone:660-726-4444
Mailing Address - Fax:660-726-4445
Practice Address - Street 1:29 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-8197
Practice Address - Country:US
Practice Address - Phone:660-726-4444
Practice Address - Fax:660-726-4445
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248491912Medicaid
MO248491912Medicaid
KS100412980JMedicaid
KSKA1021003Medicare PIN
KS0000107275OtherBCBS