Healthcare Provider Details

I. General information

NPI: 1427357987
Provider Name (Legal Business Name): AHMED A SAGASLLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-5016
US

IV. Provider business mailing address

2901 E 29TH ST
BRYAN TX
77802-2692
US

V. Phone/Fax

Practice location:
  • Phone: 702-780-0300
  • Fax: 702-608-4977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15257
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62308
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number15257
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMC-2614
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number15257
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ3086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: