Healthcare Provider Details

I. General information

NPI: 1265825541
Provider Name (Legal Business Name): ALEXANDER PINGREE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

1000 GREENLEY RD
SONORA CA
95370-5200
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2344
  • Fax:
Mailing address:
  • Phone: 209-536-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02005498A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number13482423-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13482423-1204
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO3020
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: