MEDICARE: LAURIE SUSAN SELTZER D.O.

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	2085R0202X	Diagnostic Radiology Physician	446	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578561650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE SUSAN SELTZER D.O.

Provider Business Mailing Address
First Line	:	1000 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6231
Country	:	US
Telephone Number	:	702-990-6900
Fax Number	:	702-702-3078

Provider Business Practice Location Address
First Line	:	1000 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6231
Country	:	US
Telephone Number	:	702-990-6900
Fax Number	:	702-702-3078

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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