Healthcare Provider Details

I. General information

NPI: 1679397400
Provider Name (Legal Business Name): IAN MUIR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 W SAHARA AVE
LAS VEGAS NV
89146-0355
US

IV. Provider business mailing address

5440 W SAHARA AVE STE 302
LAS VEGAS NV
89146-0361
US

V. Phone/Fax

Practice location:
  • Phone: 702-633-0207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3160
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: