Healthcare Provider Details

I. General information

NPI: 1144630344
Provider Name (Legal Business Name): JESSICA BEAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 12/20/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 W OAKEY BLVD STE 401
LAS VEGAS NV
89102-1535
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-8877
  • Fax: 702-878-3952
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18021
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number18021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: