Provider Demographics
NPI:1912072604
Name:NASR, ELIAS N (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:N
Last Name:NASR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:302 EL CAMINO REAL
Mailing Address - Street 2:STE 5
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2860
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-452-2232
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 400
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-458-0229
Practice Address - Fax:520-458-1038
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-10-01
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Provider Licenses
StateLicense IDTaxonomies
AZ36124208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159997Medicaid
AZZ128101Medicare PIN
D58849Medicare UPIN