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NPI Code Detail

MEDICARE: CRYSTAL PHARES MD

MEDICARE: CRYSTAL PHARES 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
1207P00000XEmergency Medicine Physician24559NV
2207P00000XEmergency Medicine PhysicianML60949190WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215595954
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL PHARES MD
Provider Business Mailing Address
First Line : 1600 MEDICAL PKWY
Second Line :
City : CARSON CITY
State : NV
Zip : 89703-4625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 MEDICAL PKWY
Second Line :
City : CARSON CITY
State : NV
Zip : 89703-4625
Country : US
Telephone Number : 702-469-9676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2019
Last Update Date : 02/10/2026

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Directions to “ CRYSTAL PHARES MD” Practice Location

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