Organization
LAS VEGAS MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
6850 N DURANGO DR STE 208, LAS VEGAS, NV 89149-4596
(702) 835-9870
Mailing address
367 S GULPH RD, KING OF PRUSSIA, PA 19406-3121
(775) 356-9393
(775) 356-5590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447656988
—
NV
Enumeration date
11/11/2014
Last updated
08/17/2020
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