Healthcare Provider Details

I. General information

NPI: 1114901444
Provider Name (Legal Business Name): ALEXANDER IMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 PASEO VERDE PKWY STE 100
HENDERSON NV
89012-5725
US

IV. Provider business mailing address

PO BOX 531666
HENDERSON NV
89053-1666
US

V. Phone/Fax

Practice location:
  • Phone: 702-982-7100
  • Fax: 702-982-7102
Mailing address:
  • Phone: 702-982-7100
  • Fax: 702-982-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberAI070134
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6727480001
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number12082
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: