MEDICARE: TIMOTHY VANDUZER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5710391205	UT
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	204739	NY
3	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	8687	NV

General Provider Information

NPI Number	:	1023051760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY VANDUZER MD

Provider Business Mailing Address
First Line	:	316 DAZZLING TER
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-3226
Country	:	US
Telephone Number	:	801-921-3545
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N RAINBOW BLVD
Second Line	:	SUITE 203
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1082
Country	:	US
Telephone Number	:	702-259-1228
Fax Number	:	702-259-1272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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Directions to “ TIMOTHY VANDUZER MD” Practice Location

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