=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750348645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUART ALLEN ENGEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 02/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5380 S RAINBOW BLVD STE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-379-4753
-----------------------------------------------------
Fax | 702-367-8207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5380 S RAINBOW BLVD SUITE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89118-1877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-379-4753
-----------------------------------------------------
Fax | 702-367-8207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 1497
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------