Healthcare Provider Details

I. General information

NPI: 1346942067
Provider Name (Legal Business Name): SEDALE BOIRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 N TENAYA WAY
LAS VEGAS NV
89128-0618
US

IV. Provider business mailing address

2880 N TENAYA WAY
LAS VEGAS NV
89128-0618
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-9551
  • Fax:
Mailing address:
  • Phone: 702-962-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO.OP.70124142
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: