Healthcare Provider Details

I. General information

NPI: 1255444568
Provider Name (Legal Business Name): EAR NOSE & THROAT SPECIALISTS OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 SO BURNHAM ST SUITE 345
LAS VEGAS NV
89119-5544
US

IV. Provider business mailing address

4275 SO BURNHAM ST SUITE 345
LAS VEGAS NV
89119-5544
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-7668
  • Fax: 702-735-1411
Mailing address:
  • Phone: 702-735-7668
  • Fax: 702-735-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD CHARLES MOHS JR.
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 702-735-7668