Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 20823 | NV |
N | 207RH0002X | Hospice and Palliative Medicine | 20823 | NV |
NPI | 1265814628 |
---|---|
Provider Name | Dr. Mustapha Ibrahim Serhan |
First Address | Las Vegas, NV 89148-5613 |
Second Address | Las Vegas, NV 89148-5613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 19/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265814628 | (05) | NV |
20823 | NV MEDICAL LICENSE (01) | NV |