MEDICARE: CURTIS E BAZEMORE MD PC

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	207Q00000X	Family Medicine Physician
2	207P00000X	Emergency Medicine Physician	8408	NV

General Provider Information

NPI Number	:	1952656563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURTIS E BAZEMORE MD PC

Provider Business Mailing Address
First Line	:	6424 LOSEE RD STE 100
Second Line	:
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 LOSEE RD STE 100
Second Line	:
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	:	PRESIDENT
Name	:	DR. CURTIS E BAZEMORE JR.
Credential	:	MD
Telephone Number	:	702-677-2273

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	04/08/2015

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