Healthcare Provider Details

I. General information

NPI: 1356320261
Provider Name (Legal Business Name): SCOTT L. BARANOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 S PECOS RD SUITE 2900
HENDERSON NV
89074-7177
US

IV. Provider business mailing address

7150 W. SUNSET RD. SUITE 201A
LAS VEGAS NV
89113-1982
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-8000
  • Fax: 702-735-4795
Mailing address:
  • Phone: 702-385-4342
  • Fax: 702-385-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5268
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberF9166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: