Provider Demographics
NPI:1841239118
Name:AHMED, MUSTAFA I (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:I
Last Name:AHMED
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:PO BOX 364197
Mailing Address - Street 2:
Mailing Address - City:N 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15815208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV15815OtherNV MEDICAL LICENSE
NV15815OtherNV MEDICAL LICENSE