Individual
DR. ABDUL R, NIZAM II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
630 N MORLEY ST, STE 101, MOBERLY, MO 65270-2556
(660) 263-0404
(660) 263-1725
Mailing address
630 N MORLEY ST, STE 101, MOBERLY, MO 65270-2556
(660) 263-0404
(660) 263-1725
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
113224
MO
332H00000X
Eyewear Supplier
113224
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209988542
—
MO
01
—
238605
ADVANTRA
MO
05
—
325927507
—
MO
Enumeration date
05/24/2005
Last updated
02/07/2014
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