=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285622068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAEL EID MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 08/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6040 S FORT APACHE RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-476-4900
-----------------------------------------------------
Fax | 702-476-4949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 W OLYMPIC BLVD # 1270
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91199-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-791-1454
-----------------------------------------------------
Fax | 702-946-1354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 10229
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 10229
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------