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General NPI Number Information
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NPI Number | 1104018951
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Entity Type | Individual
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Provider Name | ERIC MOLDESTAD MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 2020 PALOMINO LANE STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89106-4894
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Country | US
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Telephone | 702-759-8600
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Fax | 702-384-1815
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Provider Business Mailing Address
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Address Line | 2020 PALOMINO LN STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89106-4894
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Country | US
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Telephone | 702-759-8600
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Fax | 702-384-1815
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 350049
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 14294
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License Number State | NV
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