MEDICARE: TIMOTHY J LADNER MD PROFESSIONAL CORPORATION

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	207Q00000X	Family Medicine Physician	10562	NV

General Provider Information

NPI Number	:	1982725941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY J LADNER MD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2001 S RAINBOW BLVD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2990
Country	:	US
Telephone Number	:	702-315-4600
Fax Number	:	702-315-4607

Provider Business Practice Location Address
First Line	:	2001 S RAINBOW BLVD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2990
Country	:	US
Telephone Number	:	702-315-4600
Fax Number	:	702-315-4607

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY J LADNER
Credential	:	MD
Telephone Number	:	702-315-4600

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	12/23/2013

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