Provider Demographics
NPI:1750497756
Name:JOHN A. NASSAR, M.D., P.C.
Entity Type:Organization
Organization Name:JOHN A. NASSAR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-451-3668
Mailing Address - Street 1:9393 N 90TH ST
Mailing Address - Street 2:SUITE 102-126
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5040
Mailing Address - Country:US
Mailing Address - Phone:480-451-3668
Mailing Address - Fax:
Practice Address - Street 1:8205 N. VIA DE NEGOCIO DR.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2312
Practice Address - Country:US
Practice Address - Phone:480-451-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28964207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty