Healthcare Provider Details

I. General information

NPI: 1750354239
Provider Name (Legal Business Name): PAUL TOMASIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 W SUNSET RD STE 207 STE. 207
LAS VEGAS NV
89148-4903
US

IV. Provider business mailing address

9260 W SUNSET RD STE. 200
LAS VEGAS NV
89148-4858
US

V. Phone/Fax

Practice location:
  • Phone: 702-304-5756
  • Fax: 702-906-0933
Mailing address:
  • Phone: 702-255-3547
  • Fax: 702-921-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11487
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: