Organization
JOAQUIM S TAVARES MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAQUIM S TAVARES MD (PRESIDENT)
(702) 380-1944
Entity
Organization
Contact information
Practice address
1711 SONGLIGHT CT, LAS VEGAS, NV 89117-1584
(702) 380-1944
Mailing address
PO BOX 80624, LAS VEGAS, NV 89180-0624
(702) 380-1944
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9087
NV
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
9087
NV
207RP1001X
Pulmonary Disease Physician
Primary
9087
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9087
MEDICAL LICENSE
NV
Enumeration date
07/19/2009
Last updated
07/19/2009
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