Provider Demographics
NPI:1346225620
Name:HAQUE, NASIR M (MD)
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:M
Last Name:HAQUE
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:P O BOX 1000 DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-348-6487
Mailing Address - Fax:901-791-0338
Practice Address - Street 1:6401 POPLAR AVE STE 530
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4840
Practice Address - Country:US
Practice Address - Phone:901-348-6487
Practice Address - Fax:901-791-0338
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4340413OtherBCBS
TN3093504Medicaid
TNP00037890OtherRAILROAD MEDICARE
TN4042292OtherBCBS
TNP00037890OtherRAILROAD MEDICARE