Provider Demographics
NPI:1881681799
Name:NASSRI, LOUAY K (MD)
Entity Type:Individual
Prefix:
First Name:LOUAY
Middle Name:K
Last Name:NASSRI
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 10718
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0718
Mailing Address - Country:US
Mailing Address - Phone:479-221-3732
Mailing Address - Fax:479-649-8275
Practice Address - Street 1:9207 HIGHWAY 71 S
Practice Address - Street 2:STE 9
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9117
Practice Address - Country:US
Practice Address - Phone:479-434-6140
Practice Address - Fax:479-434-6144
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2933208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105826001Medicaid
AR100045000AMedicaid
AR100045000AMedicaid
AR105826001Medicaid