Provider Demographics
NPI:1124349063
Name:MAHGEREFTEH, BABAK (DO)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:MAHGEREFTEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S GREEN VALLEY PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0425
Mailing Address - Country:US
Mailing Address - Phone:702-427-4894
Mailing Address - Fax:
Practice Address - Street 1:650 S GREEN VALLEY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0425
Practice Address - Country:US
Practice Address - Phone:702-427-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine