Healthcare Provider Details

I. General information

NPI: 1366543720
Provider Name (Legal Business Name): JOHN PHILIP MIDDAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 POINT RIDGE PL
LAS VEGAS NV
89145-8810
US

IV. Provider business mailing address

613 POINT RIDGE PL
LAS VEGAS NV
89145-8810
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-5289
  • Fax:
Mailing address:
  • Phone: 702-629-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number12850
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: