MEDICARE: DR. LUIS A TUPAC 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	207RG0100X	Gastroenterology Physician	3129	NV

General Provider Information

NPI Number	:	1760466593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS A TUPAC MD

Provider Business Mailing Address
First Line	:	3006 S MARYLAND PARKWAY
Second Line	:	520
City	:	LAS VEGAS
State	:	NV
Zip	:	89109
Country	:	US
Telephone Number	:	702-733-2998
Fax Number	:	702-733-9741

Provider Business Practice Location Address
First Line	:	3006 S MARYLAND PARKWAY
Second Line	:	520
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2244
Country	:	US
Telephone Number	:	702-733-2998
Fax Number	:	702-733-9741

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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