Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 18840 | NV |
N | 2080P0207X | Pediatric Hematology-Oncologist | MD452999 | PA |
NPI | 1114201704 |
---|---|
Provider Name | Suraj Pratap |
First Address | Las Vegas, NV 89146-1256 |
Second Address | North Las Vegas, NV 89030-7143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2011 |
Last Update Date | 05/11/2020 |