Provider Demographics
NPI:1962493676
Name:BOUTROS, NABIL (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:
Last Name:BOUTROS
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:ONE VANTAGE WAY
Mailing Address - Street 2:SUITE B-240 MIDDLE TENNESSEE EMERGENCY PHYSICIANS, PC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:27228-1562
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-329-9479
Practice Address - Street 1:400 N. HIGHLAND AVE
Practice Address - Street 2:MIDDLE TENNESSEE MEDICAL CENTER
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:800-251-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32688207P00000X
TN41834207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453051001OtherGROUP HEALTH GRP
AZ860373636OtherHUMANA GROUP
AZ892150Medicaid
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ3981220OtherEVERCARE GRP
AZAW1436OtherHEALTHNET GRP
AZAW1436OtherHEALTHNET GRP
AZ453051001OtherGROUP HEALTH GRP