Individual
MR. BASEL AL-ADHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3006 S MARYLAND PKWY, SUITE 690, LAS VEGAS, NV 89109-2218
(702) 732-1290
(702) 732-1385
Mailing address
3090 VIALE MARCO POLO, HENDERSON, NV 89052-4131
(702) 614-6550
(702) 614-6562
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2020-0008
NM
363AS0400X
Surgical Physician Assistant
421
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2402308
—
NV
01
—
VWCLCQ
MEDICARE GROUP
NV
Enumeration date
02/27/2007
Last updated
03/04/2020
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