MEDICARE: JONATHAN B BAKTARI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	8103	NV

General Provider Information

NPI Number	:	1336181825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN B BAKTARI MD

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	STE 550
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-731-9559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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