Healthcare Provider Details

I. General information

NPI: 1023017696
Provider Name (Legal Business Name): LAURA G GITLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 SMOKE RANCH ROAD
LAS VEGAS NV
89128-3157
US

IV. Provider business mailing address

7110 SMOKE RANCH ROAD
LAS VEGAS NV
89128-3157
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-5544
  • Fax: 702-869-9993
Mailing address:
  • Phone: 702-869-5544
  • Fax: 702-869-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7692
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.064894
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: