MEDICARE: FIFE DERMATOLOGY, P.C.

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	207ND0101X	MOHS-Micrographic Surgery Physician	13164	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1225228034	OTHER	NV	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1740516699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIFE DERMATOLOGY, P.C.

Provider Business Mailing Address
First Line	:	6460 MEDICAL CENTER STREET
Second Line	:	STE 350
City	:	LAS VEGAS
State	:	NV
Zip	:	89148
Country	:	US
Telephone Number	:	702-255-6647
Fax Number	:	702-933-1444

Provider Business Practice Location Address
First Line	:	6460 MEDICAL CENTER ST
Second Line	:	STE 350
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2406
Country	:	US
Telephone Number	:	702-255-6647
Fax Number	:	702-933-1444

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. CINDY JONES
Credential	:
Telephone Number	:	702-255-6647

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	06/03/2015

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