Healthcare Provider Details

I. General information

NPI: 1205882800
Provider Name (Legal Business Name): SOUTHERN NEVADA ALLERGY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY STE 306
LAS VEGAS NV
89109-2441
US

IV. Provider business mailing address

3201 S MARYLAND PKWY STE 306
LAS VEGAS NV
89109-2441
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-1400
  • Fax: 702-735-9273
Mailing address:
  • Phone: 702-735-1400
  • Fax: 702-735-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ALAZARD
Title or Position: PHYSICIAN
Credential:
Phone: 702-735-1400