Healthcare Provider Details

I. General information

NPI: 1316259575
Provider Name (Legal Business Name): TOMAS JOSEPH KUCERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2010
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

IV. Provider business mailing address

2779 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4186
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-2290
  • Fax: 702-990-2297
Mailing address:
  • Phone: 702-990-2290
  • Fax: 702-990-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN15525
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number63605-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number274356
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16579
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: