Provider Demographics
NPI:1043282395
Name:ALQASSEM, NASSER JAMAL (MD)
Entity type:Individual
Prefix:
First Name:NASSER
Middle Name:JAMAL
Last Name:ALQASSEM
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 1:1101 9TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6432
Mailing Address - Country:US
Mailing Address - Phone:505-437-8411
Mailing Address - Fax:505-443-1753
Practice Address - Street 1:1101 9TH ST
Practice Address - Street 2:STE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:505-437-8411
Practice Address - Fax:505-443-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM20020444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94522529Medicaid
NM344303601Medicare PIN
NM94522529Medicaid