Healthcare Provider Details

I. General information

NPI: 1760466593
Provider Name (Legal Business Name): LUIS A TUPAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S MARYLAND PARKWAY 520
LAS VEGAS NV
89109-2244
US

IV. Provider business mailing address

3006 S MARYLAND PARKWAY 520
LAS VEGAS NV
89109
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-2998
  • Fax: 702-733-9741
Mailing address:
  • Phone: 702-733-2998
  • Fax: 702-733-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number3129
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: