Provider Demographics
NPI:1740535764
Name:KALIL AL-NASSIR, MD PA
Entity type:Organization
Organization Name:KALIL AL-NASSIR, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-NASSIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-724-6053
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:SUITE 430
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-727-6053
Mailing Address - Fax:409-729-9793
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:SUITE 430
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-727-6053
Practice Address - Fax:409-729-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP1443OtherTEXAS LICENSE
1639303829OtherINDIVIDUAL NPI
FA1567049OtherDEA