Provider Demographics
NPI:1063462208
Name:NASIR, LAETH S (MD)
Entity Type:Individual
Prefix:
First Name:LAETH
Middle Name:S
Last Name:NASIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1319 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-3215
Mailing Address - Country:US
Mailing Address - Phone:402-717-0420
Mailing Address - Fax:402-717-6042
Practice Address - Street 1:988095 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8095
Practice Address - Country:US
Practice Address - Phone:402-559-9800
Practice Address - Fax:402-559-9840
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE18597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557507Medicaid
NE266235Medicare ID - Type Unspecified
NE47078557507Medicaid