MEDICARE: DR. GUILLERMO JOSE TELLEZ 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	207Y00000X	Otolaryngology Physician	R-3770	AR

General Provider Information

NPI Number	:	1295715746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO JOSE TELLEZ M.D.

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD NORTH
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191-6601
Country	:	US
Telephone Number	:	702-653-2000
Fax Number	:	702-653-3398

Provider Business Practice Location Address
First Line	:	4700 LAS VEGAS BLVD NORTH
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191-6601
Country	:	US
Telephone Number	:	702-653-2000
Fax Number	:	702-653-3398

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/07/2014

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