Individual
FADI NASRALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
42125
CO
207L00000X
Anesthesiology Physician
Primary
Q6248
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
352789701
—
TX
05
—
67837557
—
CO
01
—
75-2616977-042
TRICARE
TX
01
—
8FL901
BCBS
TX
01
—
P01569607
RAIL ROAD MEDICARE
TX
Enumeration date
08/20/2006
Last updated
02/08/2016
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