Provider Demographics
NPI:1467666123
Name:NIMRI, ALEXANDER M (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:NIMRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:M
Other - Last Name:AL NIMRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:2545 E THOMAS RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-419-3378
Practice Address - Fax:602-595-1528
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178281207RN0300X
TN51146207R00000X
AZ40141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ132865Medicare PIN
AZZ131136Medicare PIN
ILK30998Medicare PIN
AZ132865Medicare PIN
ILK30998Medicare PIN