Healthcare Provider Details

I. General information

NPI: 1427468537
Provider Name (Legal Business Name): BADI EGHTERAFI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MARKS ST
HENDERSON NV
89014-6654
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-6210
  • Fax:
Mailing address:
  • Phone: 702-383-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2177
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: