Provider Demographics
NPI:1528299872
Name:ANSARI, ASIF ALI KHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ASIF
Middle Name:ALI KHAN
Last Name:ANSARI
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 1:401 N. TOM GREEN
Mailing Address - Street 2:PERMIAN BASIN KIDNEY CENTER
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-279-0905
Mailing Address - Fax:
Practice Address - Street 1:401 N. TOM GREEN
Practice Address - Street 2:PERMIAN BASIN KIDNEY CENTER
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-279-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9295207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI947540926-00OtherPRIORITYHMO