Organization
MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND JAYSON PUA M.D. (OWNER)
(702) 638-7705
Entity
Organization
Contact information
Practice address
9315 W SUNSET RD, SUITE 100, LAS VEGAS, NV 89148-5011
(702) 638-7705
(702) 638-7706
Mailing address
9315 W SUNSET RD, SUITE 100, LAS VEGAS, NV 89148-5011
(702) 638-7705
(702) 638-7706
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
12103
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100511248
—
NV
01
—
1215009782
NPI
NV
01
—
207RG0600X
TAXONOMY
—
Enumeration date
02/11/2009
Last updated
10/07/2016
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