Provider Demographics
NPI:1477582039
Name:NAZEER, IMRAN (MD)
Entity Type:Individual
Prefix:MR
First Name:IMRAN
Middle Name:
Last Name:NAZEER
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 150408
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-0408
Mailing Address - Country:US
Mailing Address - Phone:936-634-2227
Mailing Address - Fax:936-634-4658
Practice Address - Street 1:409 GASLIGHT BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3132
Practice Address - Country:US
Practice Address - Phone:936-634-2227
Practice Address - Fax:936-634-4658
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041AHOtherMEDICARE PTAN
TXG03685Medicare UPIN