Healthcare Provider Details

I. General information

NPI: 1659550614
Provider Name (Legal Business Name): TEMPLAR CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 SAN FLORENTINE AVE
LAS VEGAS NV
89141-3866
US

IV. Provider business mailing address

PO BOX 230610
LAS VEGAS NV
89105-0610
US

V. Phone/Fax

Practice location:
  • Phone: 206-350-8080
  • Fax: 775-855-5853
Mailing address:
  • Phone: 206-350-8080
  • Fax: 775-855-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2000103-426
License Number StateNV

VIII. Authorized Official

Name: KEVIN TEMPLAR
Title or Position: OWNER
Credential: MD
Phone: 206-350-8080