Healthcare Provider Details

I. General information

NPI: 1467521401
Provider Name (Legal Business Name): THOMAS L VATER DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CATHEDRAL ROCK DR 210
LAS VEGAS NV
89128-0438
US

IV. Provider business mailing address

7200 CATHEDRAL ROCK DR SUITE #210
LAS VEGAS NV
89128-0438
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-5000
  • Fax:
Mailing address:
  • Phone: 702-673-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number954
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number954
License Number StateNV

VIII. Authorized Official

Name: DR. THOMAS LUTZ VATER
Title or Position: ORTHOPEDICS SPINE SURGERY
Credential: D.O.
Phone: 702-258-5521