Provider Demographics
NPI:1760591689
Name:DARKAZALLY, NAHLA D (MD)
Entity Type:Individual
Prefix:
First Name:NAHLA
Middle Name:D
Last Name:DARKAZALLY
Suffix:
Gender:F
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 960160
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0160
Mailing Address - Country:US
Mailing Address - Phone:888-447-2450
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:877-485-4474
Practice Address - Fax:405-844-1794
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9157207P00000X
GA057349207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199246302Medicaid
SCG57349Medicaid
TX199246303Medicaid
TX8BT312OtherBCBSTX THRU SAEMA
TX8BE354OtherBCBSTX THRU AEMA
TXP00941454OtherRRMCARE THRU SAEMA
GA366474182AMedicaid
TXP00744176OtherRAILROAD THRU AEMA
GA93BFBWWMedicare PIN
TX199246303Medicaid
TX199246302Medicaid
TX8BT312OtherBCBSTX THRU SAEMA