Healthcare Provider Details

I. General information

NPI: 1275657579
Provider Name (Legal Business Name): AHMAD NOMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

840 S RANCHO DR STE 4-566
LAS VEGAS NV
89106-3837
US

V. Phone/Fax

Practice location:
  • Phone: 702-824-0420
  • Fax: 702-476-5789
Mailing address:
  • Phone: 702-824-0420
  • Fax: 702-476-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13464
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: