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General NPI Number Information
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NPI Number | 1083658298
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Entity Type | Individual
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Provider Name | BROCK T WENTZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 2231 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-383-2663
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Fax | 702-383-2682
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Provider Business Mailing Address
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Address Line | 1800 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-383-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 2007014767
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | A108401
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 15016
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License Number State | NV
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