Healthcare Provider Details

I. General information

NPI: 1528068640
Provider Name (Legal Business Name): JON L SIEMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 E FLAMINGO RD
LAS VEGAS NV
89121-6227
US

IV. Provider business mailing address

3810 E FLAMINGO RD
LAS VEGAS NV
89121-6227
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-2010
  • Fax: 702-920-8787
Mailing address:
  • Phone: 702-948-2010
  • Fax: 702-920-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9250
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9250
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: