Provider Demographics
NPI:1396737789
Name:NAWAZ, MUDASSIR (MD)
Entity type:Individual
Prefix:DR
First Name:MUDASSIR
Middle Name:
Last Name:NAWAZ
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 1:500 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 STE 800
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6681
Practice Address - Country:US
Practice Address - Phone:405-321-1004
Practice Address - Fax:405-321-1074
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine