Healthcare Provider Details

I. General information

NPI: 1922201896
Provider Name (Legal Business Name): ROBERT W SHRECK MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 PALATINE TERRACE DR
HENDERSON NV
89052-3002
US

IV. Provider business mailing address

2505 ANTHEM VILLAGE DR SUITE E-334
HENDERSON NV
89052-5505
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-8803
  • Fax: 702-733-7488
Mailing address:
  • Phone: 702-733-8803
  • Fax: 702-733-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number3373
License Number StateNV

VIII. Authorized Official

Name: DR. ROBERT SHRECK
Title or Position: PRESIDENT
Credential: MD
Phone: 702-733-8803