Healthcare Provider Details

I. General information

NPI: 1730151002
Provider Name (Legal Business Name): SCOTT HAMBRECHT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 W CHARLESTON
LAS VEGAS NV
89102
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-8625
  • Fax:
Mailing address:
  • Phone: 702-877-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9704
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: