Healthcare Provider Details

I. General information

NPI: 1649687914
Provider Name (Legal Business Name): DENYS V GOLOSHCHAPOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W. CHARLESTON BLVD.
LAS VEGAS NV
89102
US

IV. Provider business mailing address

6415 S FORT APACHE RD STE 185-1005
LAS VEGAS NV
89148-6744
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2000
  • Fax: 702-383-3620
Mailing address:
  • Phone: 702-829-6386
  • Fax: 702-479-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number23270
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2019-0248
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9610007-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number23270
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: