Provider Demographics
NPI:1821046400
Name:AL-OWIR, BASSAM S (MD)
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:S
Last Name:AL-OWIR
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 1:715 MALL RING CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6667
Mailing Address - Country:US
Mailing Address - Phone:702-483-5092
Mailing Address - Fax:702-483-6202
Practice Address - Street 1:715 MALL RING CIR STE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6667
Practice Address - Country:US
Practice Address - Phone:702-483-5092
Practice Address - Fax:702-483-6202
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10605207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1821046400Medicaid
NV1821046400Medicaid
NV38188Medicare ID - Type UnspecifiedMEDICARE