=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396056628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2010
-----------------------------------------------------
Last Update Date | 07/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8930 W SUNSET RD #350
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-304-1911
-----------------------------------------------------
Fax | 702-304-2611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1350 E FLAMINGO RD #3330
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-5263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-304-1911
-----------------------------------------------------
Fax | 702-304-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHOPEDIC SURGEON
-----------------------------------------------------
Name | DR. DOUGLAS JAY SEIP
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 702-304-1911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 44210
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------