Basic Information
| Provider Information | |||||||||
| NPI: | 1992297006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURAD M JUSSA MD PA CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2446 RAM CROSSING WAY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890748308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022703756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10301 JEFFREYS ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029399400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | JUSSA | ||||||||
| AuthorizedOfficialFirstName: | MURAD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7022703756 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 8871 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1376593145 | 05 | NV | MEDICAID | 8871 | 01 | NV | NSBME | OTHER |