Provider Demographics
NPI:1891101739
Name:RIAZ, NASHMIA (MD)
Entity Type:Individual
Prefix:
First Name:NASHMIA
Middle Name:
Last Name:RIAZ
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 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-256-9111
Mailing Address - Fax:
Practice Address - Street 1:1115 ALASKA ST STE 111
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2000
Practice Address - Country:US
Practice Address - Phone:417-505-7114
Practice Address - Fax:417-505-7814
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105318207R00000X
TXBP10059064207RE0101X
FLTRN28685207RG0300X
MO2019043901207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200086355Medicaid
MO2019043901OtherSTATE LICENSE