Healthcare Provider Details

I. General information

NPI: 1861572802
Provider Name (Legal Business Name): STEPHEN LEE SELDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S EASTERN AVE
LAS VEGAS NV
89119-7825
US

IV. Provider business mailing address

4440 S EASTERN AVE
LAS VEGAS NV
89119-7825
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-4201
  • Fax: 702-735-4106
Mailing address:
  • Phone: 702-735-4201
  • Fax: 702-735-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberNV7343
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: