Healthcare Provider Details

I. General information

NPI: 1841301256
Provider Name (Legal Business Name): TAMMY KATHRYN GEPHART DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 N DURANGO DR STE 216
LAS VEGAS NV
89149-4597
US

IV. Provider business mailing address

11401 SNOW LEOPARD DR
LAS VEGAS NV
89138-6211
US

V. Phone/Fax

Practice location:
  • Phone: 702-851-7287
  • Fax: 702-224-5653
Mailing address:
  • Phone: 248-819-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2062
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001122
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: