Healthcare Provider Details

I. General information

NPI: 1033186796
Provider Name (Legal Business Name): PETER LLOYD HILDEBRAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 WELLNESS WAY STE 402
LAS VEGAS NV
89106-4145
US

IV. Provider business mailing address

2020 WELLNESS WAY STE 402
LAS VEGAS NV
89106-4145
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-5000
  • Fax: 702-485-5005
Mailing address:
  • Phone: 702-485-5000
  • Fax: 702-485-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number19028
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19028
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: