Provider Demographics
NPI:1063465805
Name:KAMKAR, NASER (MD)
Entity Type:Individual
Prefix:
First Name:NASER
Middle Name:
Last Name:KAMKAR
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 1:4575 VIA ROYALE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1043
Mailing Address - Country:US
Mailing Address - Phone:239-277-9009
Mailing Address - Fax:239-277-9007
Practice Address - Street 1:4575 VIA ROYALE
Practice Address - Street 2:SUITE 216
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1043
Practice Address - Country:US
Practice Address - Phone:239-277-9009
Practice Address - Fax:239-277-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253009100Medicaid
FL253009100Medicaid
FLE0027AMedicare ID - Type Unspecified