Provider Demographics
NPI:1104278829
Name:NAZARI, ALI RIZA (MD)
Entity type:Individual
Prefix:
First Name:ALI RIZA
Middle Name:
Last Name:NAZARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5621 COTTAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4210
Mailing Address - Country:US
Mailing Address - Phone:251-666-2439
Mailing Address - Fax:251-666-3166
Practice Address - Street 1:4545 CORDATA PKWY STE 2C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7264
Practice Address - Country:US
Practice Address - Phone:360-752-5165
Practice Address - Fax:360-752-5686
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61545364207Q00000X
ALMD.38544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine