Healthcare Provider Details

I. General information

NPI: 1053643080
Provider Name (Legal Business Name): JORAM S SEGGEV MD CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 W LAKE MEAD BLVD # C9-292
LAS VEGAS NV
89128-0297
US

IV. Provider business mailing address

7500 W LAKE MEAD BLVD # C9-292
LAS VEGAS NV
89128-0297
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-2444
  • Fax: 702-242-0655
Mailing address:
  • Phone: 702-822-2444
  • Fax: 702-242-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORAM S SEGGEV
Title or Position: PRESIDENT
Credential: MD
Phone: 702-822-2444