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NPI Code Detail

MEDICARE: DR. JENNIFER LAUREN DAUGHARTHY MD

MEDICARE: DR. JENNIFER LAUREN DAUGHARTHY 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
1207P00000XEmergency Medicine Physician13239NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS18202OTHERNVPHARMACY/CONTROLLED SUBSTANCE CERTIFICATE
213239OTHERNVNV MEDICAL LICENSE

General Provider Information

NPI Number : 1639331630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER LAUREN DAUGHARTHY MD
Provider Business Mailing Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 310-702-5528
Fax Number : 702-710-7457
Provider Business Practice Location Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 310-702-5528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2008
Last Update Date : 08/30/2024

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