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General NPI Number Information
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NPI Number | 1134288178
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Entity Type | Organization
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Legal Business Name | LAKES DERMATOLOGY SKIN CANCER & LASER CENTER INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 8937 W SAHARA AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89117
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Country | US
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Telephone | 702-869-6667
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Fax | 702-869-2627
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Provider Business Mailing Address
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Address Line | 8937 W SAHARA AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89117
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Country | US
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Telephone | 702-869-6667
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Fax | 702-869-2627
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. ALLISON ROSE RUECKL
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Credential |
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Telephone | 702-869-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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