Healthcare Provider Details

I. General information

NPI: 1407002413
Provider Name (Legal Business Name): EAR NOSE & THROAT SPECIALISTS OF SOUTHERN NEVADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2008
Last Update Date: 08/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 BURNHAM AVE SUITE 345
LAS VEGAS NV
89119-5488
US

IV. Provider business mailing address

4275 BURNHAM AVE SUITE 345
LAS VEGAS NV
89119-5488
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-7668
  • Fax: 702-735-1411
Mailing address:
  • Phone: 702-735-7668
  • Fax: 702-735-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number8239
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number8239
License Number StateNV

VIII. Authorized Official

Name: DR. DONALD CHARLES MOHS
Title or Position: PRESIDENT
Credential: MD
Phone: 702-735-7668