Provider Demographics
NPI:1659331387
Name:ONBIRBAK, BRIAN BEHNAM (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:BEHNAM
Last Name:ONBIRBAK
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 1:1995 ALCOVA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1551
Mailing Address - Country:US
Mailing Address - Phone:702-383-2691
Mailing Address - Fax:702-388-4114
Practice Address - Street 1:2300 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4506
Practice Address - Country:US
Practice Address - Phone:702-383-2691
Practice Address - Fax:402-388-4114
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7161207R00000X
AZ25730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12-02877/001102877Medicaid
NV12-02877/001102877Medicaid