Healthcare Provider Details

I. General information

NPI: 1326143660
Provider Name (Legal Business Name): DEURELL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 S FORT APPACHE RD SUITE 101
LAS VEGAS NV
89147
US

IV. Provider business mailing address

4840 S FORT APPACHE RD SUITE 101
LAS VEGAS NV
89147
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-5437
  • Fax: 702-367-1698
Mailing address:
  • Phone: 702-450-5437
  • Fax: 702-367-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11440
License Number StateNV

VIII. Authorized Official

Name: ERIC G DEURELL
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 702-450-5437