Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | S4-286 | NV |
NPI | 1093870248 |
---|---|
Provider Name | Dr. Michael Neubauer |
First Address | Las Vegas, NV 89102-2353 |
Second Address | Las Vegas, NV 89102-2353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100510865 | (05) | NV |