Basic Information
Provider Information
NPI: 1003006602
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NASAJPOUR
FirstName: HOSSEIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 247
Address2:  
City: LAUREL
State: MS
PostalCode: 394410247
CountryCode: US
TelephoneNumber: 6014257522
FaxNumber: 6014287841
Practice Location
Address1: 1410 JEFFERSON ST
Address2:  
City: LAUREL
State: MS
PostalCode: 394404243
CountryCode: US
TelephoneNumber: 6014257522
FaxNumber: 6014287841
Other Information
ProviderEnumerationDate: 07/30/2007
LastUpdateDate: 02/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMD200014LAN Allopathic & Osteopathic PhysiciansSurgery 
2086S0122X21406MSY Allopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery

No ID Information.


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