Provider Demographics
NPI:1609953603
Name:SOROUR, NAGUI NABIL (MD)
Entity Type:Individual
Prefix:
First Name:NAGUI
Middle Name:NABIL
Last Name:SOROUR
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 1:999 S FAIRMONT AVE #100
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240
Mailing Address - Country:US
Mailing Address - Phone:209-334-2010
Mailing Address - Fax:209-334-0132
Practice Address - Street 1:999 S FAIRMONT AVE #100
Practice Address - Street 2:LODI
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-2010
Practice Address - Fax:209-334-0132
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3121002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0200005210OtherRAILROAD MEDICARE
CA942658928OtherCOMMERICAL INSURANCE
CA00A312100Medicaid
CA0200005210OtherRAILROAD MEDICARE
CA00A312100Medicaid
CA00A312100Medicare PIN