Provider Demographics
NPI:1235338641
Name:HIJAZI, BISHR (MD)
Entity Type:Individual
Prefix:
First Name:BISHR
Middle Name:
Last Name:HIJAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BISHR
Other - Middle Name:
Other - Last Name:HIJAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4982 SOUTH RAINBOW BLVD
Mailing Address - Street 2:UNIT #100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1111
Mailing Address - Country:US
Mailing Address - Phone:702-233-4100
Mailing Address - Fax:702-233-9002
Practice Address - Street 1:4982 SOUTH RAINBOW BLVD
Practice Address - Street 2:UNIT #100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-233-4100
Practice Address - Fax:702-233-9002
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV122982086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407028426Medicaid
NV1235338641Medicaid