Provider Demographics
NPI:1407800766
Name:SALEH, MOHAMED OMAR (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:OMAR
Last Name:SALEH
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 1:1408 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:84146-3137
Mailing Address - Country:US
Mailing Address - Phone:702-202-0099
Mailing Address - Fax:904-346-0887
Practice Address - Street 1:1408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3137
Practice Address - Country:US
Practice Address - Phone:702-202-0099
Practice Address - Fax:904-346-0887
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV117842084F0202X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046190300Medicaid
FL043502Medicare UPIN
FL04350Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
FL046190300Medicaid