Provider Demographics
NPI:1114901444
Name:IMAS, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:IMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531666
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1666
Mailing Address - Country:US
Mailing Address - Phone:702-982-7100
Mailing Address - Fax:702-982-7102
Practice Address - Street 1:1358 PASEO VERDE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5725
Practice Address - Country:US
Practice Address - Phone:702-982-7100
Practice Address - Fax:702-982-7102
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAI070134204C00000X
NV6727480001332B00000X
NV12082208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376795823OtherGROUP NPI
NV1376795823OtherGROUP NPI
NV6727480001Medicare NSC
NV1376795823OtherGROUP NPI
MIH67364Medicare UPIN