Provider Demographics
NPI:1457660466
Name:BASHIR, NOMAN ALAM
Entity Type:Individual
Prefix:MR
First Name:NOMAN
Middle Name:ALAM
Last Name:BASHIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15739 SW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5420
Mailing Address - Country:US
Mailing Address - Phone:305-297-9510
Mailing Address - Fax:
Practice Address - Street 1:15739 SW 102ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5420
Practice Address - Country:US
Practice Address - Phone:305-297-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1095084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant