Provider Demographics
NPI:1821450545
Name:SOUTHERN NEVADA BARIATRICS MUSTAFA AHMED MD FACS PLLC
Entity Type:Organization
Organization Name:SOUTHERN NEVADA BARIATRICS MUSTAFA AHMED MD FACS PLLC
Other - Org Name:SOUTHERN NEVADA BARIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:I
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-626-0499
Mailing Address - Street 1:PO BOX 364197
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036-8197
Mailing Address - Country:US
Mailing Address - Phone:702-626-0499
Mailing Address - Fax:702-707-0319
Practice Address - Street 1:3599 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3344
Practice Address - Country:US
Practice Address - Phone:702-626-0499
Practice Address - Fax:702-707-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15815208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15815OtherNV MEDICAL LICENSE