Unknown Individual – General Practice Physician, NPI 1306849104
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
McCarran International Airport, 5757, Wayne Newton Boulevard, Enterprise, Clark County, Nevada, 89154, United States
LAS VEGAS, NV 891251737
Phone: (702) 671-6835
Fax: (702) 671-6883
Type: Mailing
Fremont Street, Five Points, Las Vegas, Clark County, Nevada, 89169-1814, United States
LAS VEGAS, NV 891015621
Phone: (702) 671-6835
Fax: (702) 671-6883
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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.
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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 89125)
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