Healthcare Provider Details

I. General information

NPI: 1710965348
Provider Name (Legal Business Name): GEORGE BRADLEY KAISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD 230
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

2040 W CHARLESTON BLVD 202-A
LAS VEGAS NV
89102-2227
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5060
  • Fax: 702-671-2376
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5792
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: