Healthcare Provider Details

I. General information

NPI: 1699146373
Provider Name (Legal Business Name): DAULAT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 SMOKE RANCH RD SUITE 120
LAS VEGAS NV
89128-8306
US

IV. Provider business mailing address

7106 SMOKE RANCH RD SUITE 120
LAS VEGAS NV
89128-8306
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-4917
  • Fax: 702-562-8680
Mailing address:
  • Phone: 702-565-4917
  • Fax: 702-562-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number799
License Number StateNV

VIII. Authorized Official

Name: DR. GAUTAM DAULAT
Title or Position: OWNER
Credential: D.O.
Phone: 702-565-4917