Healthcare Provider Details

I. General information

NPI: 1033384896
Provider Name (Legal Business Name): KID DOCTORS URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 S FORT APACHE 101
LAS VEGAS NV
89147-7949
US

IV. Provider business mailing address

4840 S FORT APACHE ROAD 101
LAS VEGAS NV
89147-7949
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-5437
  • Fax: 702-367-1698
Mailing address:
  • Phone: 702-254-5437
  • Fax: 702-367-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number2081
License Number StateNV

VIII. Authorized Official

Name: DR. ERIC DEURELL
Title or Position: OWNER
Credential: MD
Phone: 702-450-5437