Provider Demographics
NPI:1437175056
Name:NASIR, AEJAZ (MBBS)
Entity Type:Individual
Prefix:
First Name:AEJAZ
Middle Name:
Last Name:NASIR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 PALMBRUSH TRL STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2915
Mailing Address - Country:US
Mailing Address - Phone:941-757-4800
Mailing Address - Fax:941-757-4803
Practice Address - Street 1:11505 PALMBRUSH TRL STE 120
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2915
Practice Address - Country:US
Practice Address - Phone:941-757-4800
Practice Address - Fax:941-757-4803
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147477207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56278OtherBLUE CROSS BLUE SHIELD
FLU8890ZMedicare PIN
FLI65769Medicare UPIN