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NPI Code Detail

MEDICARE: DAVID VANSOMPHONE MD LTD

MEDICARE: DAVID VANSOMPHONE 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
1207R00000XInternal Medicine Physician9448NV

General Provider Information

NPI Number : 1750598165
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID VANSOMPHONE MD LTD
Provider Business Mailing Address
First Line : PO BOX 35984
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5984
Country : US
Telephone Number : 702-597-1597
Fax Number :
Provider Business Practice Location Address
First Line : 5375 S FORT APACHE RD
Second Line : SUITE 101
City : LAS VEGAS
State : NV
Zip : 89148-7623
Country : US
Telephone Number : 702-597-1597
Fax Number :
Authorized Official
Title or Position : ACCTS. MGR
Name : LORI LABRECQUE
Credential :
Telephone Number : 702-453-3799
Provider Enumeration Date : 05/16/2007
Last Update Date : 05/17/2010

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Directions to “DAVID VANSOMPHONE MD LTD ” Practice Location

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