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General NPI Number Information
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NPI Number | 1114073285
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DERMATOLOGY INSTITUTE LTD
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 2900 E DESERT INN RD 202
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City | LAS VEGAS
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State | NV
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Zip | 89121-3619
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Country | US
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Telephone | 702-731-0933
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Fax | 702-731-9928
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Provider Business Mailing Address
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Address Line | 2900 E DESERT INN RD 202
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City | LAS VEGAS
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State | NV
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Zip | 89121-3619
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Country | US
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Telephone | 702-731-0933
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Fax | 702-731-9928
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. MARTIN J SAFKO
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Credential | M.D.
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Telephone | 702-731-0933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5369
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License Number State | NV
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