Provider Demographics
NPI:1376956631
Name:IMAN, DREW JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:JOSEPH
Last Name:IMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:DREW
Other - Last Name:IMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2231 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2254
Mailing Address - Country:US
Mailing Address - Phone:702-383-2663
Mailing Address - Fax:
Practice Address - Street 1:2231 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2254
Practice Address - Country:US
Practice Address - Phone:702-383-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021030207X00000X
FLOS16167207XS0114X
NVDO3258207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery