MEDICARE: DR. GEORGES Y TANNOURY 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	207R00000X	Internal Medicine Physician	8820	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1639143423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGES Y TANNOURY MD

Provider Business Mailing Address
First Line	:	3144 BEACH VIEW COURT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117
Country	:	US
Telephone Number	:	702-510-5447
Fax Number	:	702-684-7469

Provider Business Practice Location Address
First Line	:	2001 S RAINBOW BLVD
Second Line	:	STE, 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2990
Country	:	US
Telephone Number	:	702-315-4600
Fax Number	:	702-315-4607

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	02/05/2016

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