Unknown Individual – Obstetrics & Gynecology Physician, NPI 1073507794

Obstetrics & Gynecology Physician

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Obstetrics & Gynecology Physician. They hold a License No. 9581 (NV). The NPI Number for Unknown Individual is 1073507794

Main info

Organization

Inactive

29 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1073507794

Phone

(702) 255-3547

Address

9260 W SUNSET RD

Deactivation Date

28 January 2022

Doctor Profile

Medical School Name

UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE

Secondary Phone

7022553547

Graduation Year

1997 (29 years ago)

PAC ID

9638082142

Group Practice PAC ID

5991866303

Professional Enrollment ID

I20120424000579

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

West Sunset Road, Henderson, Clark County, Nevada, 89120, United States
STE. 200
LAS VEGAS, NV 891484858
Phone: (702) 255-3547
Fax: (702) 921-2419
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89148)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5991866303View full group profile

Name	Specialty	State
ELRAH F GFELLER (PA-C)	-	NV
DR. KIMBALL YUNG HUANG (MD)	-	NV
LINDIANE SHULTIS	-	NV
DR. KEITH G BOMAN (M.D.)	-	NV
DANIELLA COURBAN (MD)	-	NV
FRANK L ANDERSON (DO)	-	NV
ANDINWOH OROCK (PA-C)	-	NV
BARBARA J STOCKING (MD)	-	AZ
MATTHEW ESPINOSA (FNP)	-	NV
JOHN BRADLEY BEDOTTO (M.D.)	-	NV