Organization
SUHATTAI GAMNERDSIRI MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUHATTAI GAMNERDSIRI MD (PRESIDENT)
(702) 367-9300
Entity
Organization
Contact information
Practice address
2000 PINTO LN, STE 200, LAS VEGAS, NV 89106-4045
(702) 367-9300
(702) 367-9400
Mailing address
2000 PINTO LN, STE 200, LAS VEGAS, NV 89106-4045
(702) 367-9300
(702) 367-9400
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
9094
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018154
—
NV
01
—
CC1182
NEVADA BLUE SHIELD
NV
Enumeration date
02/10/2013
Last updated
01/08/2020
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