Provider Demographics
NPI:1477538940
Name:NOUSARI, CARLOS H (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:H
Last Name:NOUSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:895 SW 30TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:954-633-3387
Practice Address - Fax:954-633-3217
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88101207N00000X, 207NI0002X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267461100Medicaid
FL267461100Medicaid
FL71442VMedicare PIN