Healthcare Provider Details

I. General information

NPI: 1821046400
Provider Name (Legal Business Name): BASSAM S AL-OWIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-5092
  • Fax: 702-483-6202
Mailing address:
  • Phone: 702-483-5092
  • Fax: 702-483-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number10605
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: