Healthcare Provider Details

I. General information

NPI: 1346308947
Provider Name (Legal Business Name): CLARE E CLOSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2931
US

IV. Provider business mailing address

2653 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2931
US

V. Phone/Fax

Practice location:
  • Phone: 702-220-4006
  • Fax: 702-655-4005
Mailing address:
  • Phone: 702-220-4006
  • Fax: 702-655-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number0101280695
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7840
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number7840
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: