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General NPI Number Information
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NPI Number | 1659550614
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Entity Type | Organization
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Legal Business Name | TEMPLAR CLINICS
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 5590 SAN FLORENTINE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89141-3866
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Country | US
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Telephone | 206-350-8080
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Fax | 775-855-5853
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Provider Business Mailing Address
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Address Line | PO BOX 230610
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City | LAS VEGAS
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State | NV
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Zip | 89105-0610
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Country | US
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Telephone | 206-350-8080
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Fax | 775-855-5853
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN TEMPLAR
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Credential | MD
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Telephone | 206-350-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 2000103-426
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License Number State | NV
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