MEDICARE: DR. PETER PHILANDER 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	207Q00000X	Family Medicine Physician	8535	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V36436	OTHER	NV	MEDICARE PTAN

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
3	CS09273	OTHER	NV	PHARMACY/CDS

General Provider Information

NPI Number	:	1437137247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PHILANDER M.D.

Provider Business Mailing Address
First Line	:	2481 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0825
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

Provider Business Practice Location Address
First Line	:	2481 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0825
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. PETER PHILANDER M.D.” Practice Location

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