Provider Demographics
NPI:1437367901
Name:RAD POUR, OMID (MD)
Entity Type:Individual
Prefix:DR
First Name:OMID
Middle Name:
Last Name:RAD POUR
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 400475
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0475
Mailing Address - Country:US
Mailing Address - Phone:702-696-7256
Mailing Address - Fax:702-796-7256
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-696-7256
Practice Address - Fax:702-796-7256
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21625207RE0101X
TN47788207RE0101X
NV16069207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06620853Medicaid
MS302I468028Medicare PIN
TN103I463276Medicare PIN