Provider Demographics
NPI:1952656563
Name:CURTIS E BAZEMORE MD PC
Entity Type:Organization
Organization Name:CURTIS E BAZEMORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-677-2273
Mailing Address - Street 1:6424 LOSEE RD STE 100
Mailing Address - Street 2:
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 LOSEE RD STE 100
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8408207P00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty