Healthcare Provider Details

I. General information

NPI: 1689372989
Provider Name (Legal Business Name): MAXWELL O. VEST, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 S JONES BLVD
LAS VEGAS NV
89146-1231
US

IV. Provider business mailing address

6 FIRE ROCK CT
LAS VEGAS NV
89141-6041
US

V. Phone/Fax

Practice location:
  • Phone: 618-558-3221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXWELL OMER VEST
Title or Position: EMPLOYER
Credential: MD
Phone: 618-558-3221