Healthcare Provider Details

I. General information

NPI: 1306111950
Provider Name (Legal Business Name): STEVEN A HOLPER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 W CHARLESTON BLVD SUITE 202
LAS VEGAS NV
89102-1938
US

IV. Provider business mailing address

3233 W CHARLESTON BLVD SUITE 202
LAS VEGAS NV
89102-1938
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-3510
  • Fax: 702-878-1405
Mailing address:
  • Phone: 702-878-3510
  • Fax: 702-878-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6061
License Number StateNV

VIII. Authorized Official

Name: STEVEN A HOLPER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-878-3510