Healthcare Provider Details

I. General information

NPI: 1174923221
Provider Name (Legal Business Name): F. VICTOR RUECKL DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8861 W SAHARA AVE STE 290
LAS VEGAS NV
89117-4808
US

IV. Provider business mailing address

8861 W SAHARA AVE STE 290
LAS VEGAS NV
89117-4808
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-6667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE RUECKL
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-869-6667