Healthcare Provider Details

I. General information

NPI: 1013242791
Provider Name (Legal Business Name): HOWARD G GELFAND MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E LAKE MEAD BLVD
N LAS VEGAS NV
89030-7120
US

IV. Provider business mailing address

2660 CRIMSON CANYON DR STE 130
LAS VEGAS NV
89128-0846
US

V. Phone/Fax

Practice location:
  • Phone: 702-808-5579
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number8401
License Number StateNV

VIII. Authorized Official

Name: MRS. LORI LABRECQUE
Title or Position: ACCT. MGR
Credential:
Phone: 702-453-3799