Individual
DR. CHARLES HENRY TADLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6725 S. EASTERN AVE. #6, LAS VEGAS, NV 89119
(702) 474-0200
(702) 474-7165
Mailing address
6725 S. EASTERN AVE. #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
5937479-1205
UT
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
8402
NV
207LP2900X
Pain Medicine (Anesthesiology) Physician
G62878
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
394875
—
AZ
01
—
EN880Y
JULIE BROWN, FNP MEDICARE PIN
NV
01
—
FB250Z
GERALD JONES MEDICARE NV
NV
Enumeration date
09/15/2005
Last updated
10/19/2011
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