Provider Demographics
NPI:1457387888
Name:NASSER, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:NASSER
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 1:8550 NE 138TH LN STE 401
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8957
Mailing Address - Country:US
Mailing Address - Phone:352-347-2315
Mailing Address - Fax:352-854-8192
Practice Address - Street 1:8550 NE 138TH LN STE 401
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-347-2315
Practice Address - Fax:352-854-8192
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83972207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266845900Medicaid
FL266845900Medicaid
FL060070119OtherRAILROAD MEDICARE
FL060070119OtherRAILROAD MEDICARE
FLH69963Medicare UPIN