Healthcare Provider Details

I. General information

NPI: 1720348725
Provider Name (Legal Business Name): JOHN M CLAIR DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ADAMS BLVD
BOULDER CITY NV
89005-2213
US

IV. Provider business mailing address

6955 N DURANGO DR SUITE 1115-298
LAS VEGAS NV
89149-4411
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-4111
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO1452
License Number StateNV

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS MGR
Credential:
Phone: 702-453-3799