Healthcare Provider Details

I. General information

NPI: 1932292778
Provider Name (Legal Business Name): ALEXANDER R SPARKUHL MD & RANJIT UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN 430
LAS VEGAS NV
89106-4126
US

IV. Provider business mailing address

700 SHADOW LN 430
LAS VEGAS NV
89106-4126
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-0500
  • Fax: 702-384-0093
Mailing address:
  • Phone: 702-384-0500
  • Fax: 702-384-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberQ07005455023890
License Number StateNV

VIII. Authorized Official

Name: ALEXANDER R SPARKUHL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-384-0500