Organization
CHARLES H. TADLOCK, M.D. LTD
Active
Other names
CENTER FOR PAIN MANAGEMENT
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES HENRY TADLOCK M.D. (PRESIDENT)
(702) 474-0200
Entity
Organization
Contact information
Practice address
6725 S. EASTERN AVE., SUITE 6, LAS VEGAS, NV 89119
(702) 474-0200
(702) 946-5328
Mailing address
6725 S. EASTERN AVE., SUITE 6, LAS VEGAS, NV 89119
(702) 474-0200
(702) 474-7165
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
26067
AZ
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
48411
NV
207LP2900X
Pain Medicine (Anesthesiology) Physician
8402
NV
363AM0700X
Medical Physician Assistant
PA1256
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100502539
—
NV
Enumeration date
05/09/2007
Last updated
10/13/2015
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