Healthcare Provider Details

I. General information

NPI: 1164489480
Provider Name (Legal Business Name): JASON E GARBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 S DURANGO DR
LAS VEGAS NV
89117-9186
US

IV. Provider business mailing address

3012 S DURANGO DR
LAS VEGAS NV
89117-9186
US

V. Phone/Fax

Practice location:
  • Phone: 702-835-0088
  • Fax: 702-826-3162
Mailing address:
  • Phone: 702-835-0088
  • Fax: 702-826-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number31604
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5420789-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number10131
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: