Healthcare Provider Details

I. General information

NPI: 1568111714
Provider Name (Legal Business Name): BENJAMIN TULLEY HAIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

9033 LEADING CT
LAS VEGAS NV
89149-3081
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-5000
  • Fax:
Mailing address:
  • Phone: 801-597-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberSL1925
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: