MEDICARE: JORAM S. SEGGEV 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	207K00000X	Allergy & Immunology Physician	6303	NV
2	207RP1001X	Pulmonary Disease Physician	6303	NV
3	207R00000X	Internal Medicine Physician	6303	NV

General Provider Information

NPI Number	:	1225010523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORAM S. SEGGEV MD

Provider Business Mailing Address
First Line	:	7500 W LAKE MEAD BLVD
Second Line	:	C9-292
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0297
Country	:	US
Telephone Number	:	702-822-2444
Fax Number	:	702-242-0655

Provider Business Practice Location Address
First Line	:	7500 W LAKE MEAD BLVD
Second Line	:	C9-292
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0297
Country	:	US
Telephone Number	:	702-822-2444
Fax Number	:	702-242-0655

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	01/29/2015

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