Individual
DR. STEPHEN J IACOBONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3006 S MARYLAND PKWY STE 205, LAS VEGAS, NV 89109
(702) 735-7154
(702) 735-7153
Mailing address
PO BOX 21015, 521 HAMMILL LN., RENO, NV 89515
(775) 827-0707
(775) 827-1006
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
M8193
ID
207RX0202X
Medical Oncology Physician
Primary
MD00024072
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497706162
—
NV
05
—
1497706162
—
WA
01
—
15296
STATE LICENSE
NV
05
—
805994300
—
ID
Enumeration date
05/15/2006
Last updated
05/18/2018
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