Provider Demographics
NPI:1477619831
Name:BAZEMORE, CURTIS EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:EUGENE
Last Name:BAZEMORE
Suffix:JR
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 1:6424 LOSEE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-0102
Mailing Address - Country:US
Mailing Address - Phone:702-677-2273
Mailing Address - Fax:702-330-3332
Practice Address - Street 1:6424 LOOSEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-0102
Practice Address - Country:US
Practice Address - Phone:702-677-2273
Practice Address - Fax:702-330-3332
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8408207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC8555OtherBLUE CROSS
NV100503818Medicaid
NV8551OtherMEDICARE ENROLLMENT TYPE
NV8551OtherMEDICARE ENROLLMENT TYPE
NVDC155WMedicare PIN
NVCC8555OtherBLUE CROSS
NVV39168Medicare ID - Type UnspecifiedGROUP