Healthcare Provider Details

I. General information

NPI: 1295776706
Provider Name (Legal Business Name): SILVER STATE FAMILY PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E PRATER WAY STE 215
SPARKS NV
89434-9634
US

IV. Provider business mailing address

2345 E PRATER WAY STE 215
SPARKS NV
89434-9634
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-1818
  • Fax: 775-284-1203
Mailing address:
  • Phone: 775-356-1818
  • Fax: 775-284-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number1425
License Number StateNV

VIII. Authorized Official

Name: ELIZABETH JAFFE
Title or Position: PHYSICIAN
Credential: MD
Phone: 775-356-1818