MEDICARE: DR. GAUTAM DAULAT D.O.

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	207R00000X	Internal Medicine Physician	DO 799	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00883737	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1295709418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAUTAM DAULAT D.O.

Provider Business Mailing Address
First Line	:	39 DRIFTING SHADOW WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-7879
Country	:	US
Telephone Number	:	702-565-4917
Fax Number	:	702-562-8680

Provider Business Practice Location Address
First Line	:	3416 N BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7424
Country	:	US
Telephone Number	:	702-565-4917
Fax Number	:	702-562-8680

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/05/2017

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Directions to “ DR. GAUTAM DAULAT D.O.” Practice Location

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