Healthcare Provider Details

I. General information

NPI: 1881303824
Provider Name (Legal Business Name): ANDREW GEPHARDT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 S CIMARRON RD
LAS VEGAS NV
89113-2159
US

IV. Provider business mailing address

7220 S CIMARRON RD STE 270
LAS VEGAS NV
89113-2160
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-4100
  • Fax: 702-912-4101
Mailing address:
  • Phone: 702-912-4100
  • Fax: 702-912-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: