Provider Demographics
NPI:1447681390
Name:MUDASSIR NAWAZ, M.D. PC
Entity type:Organization
Organization Name:MUDASSIR NAWAZ, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDASSIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-321-1004
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-321-1004
Mailing Address - Fax:405-321-1074
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:SUITE 800
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-321-1004
Practice Address - Fax:405-321-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24893261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200109440AMedicaid
OK200109440AMedicaid