MEDICARE: BROCK T WENTZ M.D.

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	207XX0801X	Orthopaedic Trauma Physician	2007014767	MO
2	207XX0801X	Orthopaedic Trauma Physician	A108401	CA
3	207XX0801X	Orthopaedic Trauma Physician	15016	NV

General Provider Information

NPI Number	:	1083658298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCK T WENTZ M.D.

Provider Business Mailing Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2663
Fax Number	:	702-383-2682

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/10/2023

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