Healthcare Provider Details

I. General information

NPI: 1023051760
Provider Name (Legal Business Name): TIMOTHY VANDUZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD SUITE 203
LAS VEGAS NV
89107-1082
US

IV. Provider business mailing address

316 DAZZLING TER
HENDERSON NV
89012-3226
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1228
  • Fax: 702-259-1272
Mailing address:
  • Phone: 801-921-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5710391205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number204739
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number8687
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: