MEDICARE: CURTIS EUGENE BAZEMORE JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	8408	NV
2	207Q00000X	Family Medicine Physician	8408	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8551	OTHER	NV	MEDICARE ENROLLMENT TYPE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC8555	OTHER	NV	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477619831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS EUGENE BAZEMORE JR. M.D.

Provider Business Mailing Address
First Line	:	6424 LOSEE RD
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-0102
Country	:	US
Telephone Number	:	702-677-2273
Fax Number	:	702-330-3332

Provider Business Practice Location Address
First Line	:	6424 LOOSEE RD
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-0102
Country	:	US
Telephone Number	:	702-677-2273
Fax Number	:	702-330-3332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	02/12/2015

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