Provider Demographics
NPI:1093726887
Name:NOFAL, ASHRAF M (MD)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:M
Last Name:NOFAL
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:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38702-1734
Mailing Address - Country:US
Mailing Address - Phone:662-725-2749
Mailing Address - Fax:662-725-2741
Practice Address - Street 1:227 E STARLING ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4772
Practice Address - Country:US
Practice Address - Phone:662-378-5500
Practice Address - Fax:662-378-9800
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117489Medicaid
AR161776001Medicaid
AR161776001Medicaid
MS370000462Medicare PIN