Provider Demographics
NPI:1952558926
Name:NAZZAL, MUSTAFA DM (MD, MLS, FACS)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:DM
Last Name:NAZZAL
Suffix:
Gender:M
Credentials:MD, MLS, FACS
Other - Prefix:
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Mailing Address - Street 1:3635 VISTA AVE
Mailing Address - Street 2:FDT 11TH FLOOR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:419-508-6361
Mailing Address - Fax:314-268-5400
Practice Address - Street 1:1225 S GRAND BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-3760
Practice Address - Fax:314-257-3761
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014026523204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery