Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 1308 | NV |
Y | 208200000X | Surgeon | 1308 | NV |
Y | 208600000X | Surgeon | 1308 | NV |
NPI | 1952485179 |
---|---|
Provider Name | Dr. Samir Pancholi |
First Address | Las Vegas, NV 89117-1973 |
Second Address | Las Vegas, NV 89113-2280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 01/11/2019 |