Healthcare Provider Details

I. General information

NPI: 1285622068
Provider Name (Legal Business Name): WAEL EID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5613
US

IV. Provider business mailing address

1801 W OLYMPIC BLVD # 1270
PASADENA CA
91199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-4900
  • Fax: 702-476-4949
Mailing address:
  • Phone: 702-791-1454
  • Fax: 702-946-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number10229
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10229
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: