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General NPI Number Information
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NPI Number | 1659538247
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Entity Type | Organization
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Legal Business Name | ENSIGN FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 5771 S FORT APACHE RD SUITE #100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5626
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Country | US
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Telephone | 702-951-3400
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Fax | 702-951-3403
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Provider Business Mailing Address
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Address Line | 5771 S FORT APACHE RD SUITE #100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5626
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Country | US
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Telephone | 702-951-3400
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Fax | 702-951-3403
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. SANFORD F WHITE
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Credential | M.D.
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Telephone | 702-951-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10240
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License Number State | NV
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