Healthcare Provider Details

I. General information

NPI: 1710121710
Provider Name (Legal Business Name): RUSSELL TAD LAUVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

2040 W CHARLESTON BLVD
LAS VEGAS NV
89102-2227
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5815
  • Fax:
Mailing address:
  • Phone: 702-671-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO1676
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: