Healthcare Provider Details

I. General information

NPI: 1164430005
Provider Name (Legal Business Name): SCOTT A. SLAVIS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S MARYLAND PKWY 420
LAS VEGAS NV
89109-2309
US

IV. Provider business mailing address

3121 S MARYLAND PKWY 420
LAS VEGAS NV
89109-2309
US

V. Phone/Fax

Practice location:
  • Phone: 702-796-8669
  • Fax: 702-796-9517
Mailing address:
  • Phone: 702-796-8669
  • Fax: 702-796-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5898
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number5898
License Number StateNV

VIII. Authorized Official

Name: MR. DAVID A KOPASZ
Title or Position: MANAGER
Credential:
Phone: 702-369-9814