MEDICARE: JEREMY MARC LIPSHUTZ 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	207L00000X	Anesthesiology Physician	13042	NV
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	13042	NV
3	208100000X	Physical Medicine & Rehabilitation Physician	13042	NV
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	13042	NV
5	208VP0014X	Interventional Pain Medicine Physician	13042	NV

General Provider Information

NPI Number	:	1679675060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MARC LIPSHUTZ MD

Provider Business Mailing Address
First Line	:	6120 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6760
Country	:	US
Telephone Number	:	702-948-8660
Fax Number	:	702-483-6663

Provider Business Practice Location Address
First Line	:	6120 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-948-8660
Fax Number	:	702-483-6663

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	12/15/2023

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