Provider Demographics
NPI:1922028513
Name:NOORI, NAZAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZAR
Middle Name:A
Last Name:NOORI
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 86459
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080
Mailing Address - Country:US
Mailing Address - Phone:602-251-8316
Mailing Address - Fax:480-333-5165
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-251-8316
Practice Address - Fax:480-333-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7071174400000X
AZ35685208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078HBOtherBC/BS OF TEXAS
TX046212902Medicaid
TX110230170OtherRAILROAD MEDICARE
TX0078HBOtherBC/BS OF TEXAS
TX046212902Medicaid