MEDICARE: JONATHAN C REBOTON MD LTD

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	7569	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	:	1639210974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN C REBOTON MD LTD

Provider Business Mailing Address
First Line	:	1905 MCDANIEL ST
Second Line	:	SUITE 101
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7169
Country	:	US
Telephone Number	:	702-307-8618
Fax Number	:	702-307-6819

Provider Business Practice Location Address
First Line	:	1905 MCDANIEL ST
Second Line	:	SUITE 101
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7169
Country	:	US
Telephone Number	:	702-307-8618
Fax Number	:	702-307-6819

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN C REBOTON
Credential	:	MD
Telephone Number	:	702-307-8618

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	05/21/2015

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