Healthcare Provider Details

I. General information

NPI: 1265407183
Provider Name (Legal Business Name): ALAN JEFFREY SACKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GOLDRING AVE SUITE 404
LAS VEGAS NV
89106-4000
US

IV. Provider business mailing address

2020 GOLDRING AVE SUITE 404
LAS VEGAS NV
89106-4000
US

V. Phone/Fax

Practice location:
  • Phone: 702-471-7721
  • Fax: 702-471-7780
Mailing address:
  • Phone: 702-471-7721
  • Fax: 702-471-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number9280
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: