MEDICARE: MR. CONRADO D FERRER PAC

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	363AM0700X	Medical Physician Assistant	109	NV

General Provider Information

NPI Number	:	1487741922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONRADO D FERRER PAC

Provider Business Mailing Address
First Line	:	7632 CRUZ BAY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7284
Country	:	US
Telephone Number	:	702-280-2240
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W FLAMINGO ROAD
Second Line	:	SUITE 2100
City	:	LAS VEGAS
State	:	NV
Zip	:	89103
Country	:	US
Telephone Number	:	702-822-5000
Fax Number	:	702-822-5001

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/31/2014

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