Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 21500 | NV |
N | 204F00000X | Transplant Surgeon | 216816 | NY |
NPI | 1093765448 |
---|---|
Provider Name | Mark R Laftavi |
First Address | Las Vegas, NV 89102 |
Second Address | Las Vegas, NV 89106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02162370 | (05) | NY |
G90288 | (02) | NY |