Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 204739 | NY |
N | 207PE0004X | Emergency Medical Services | 5710391205 | UT |
Y | 207PE0004X | Emergency Medical Services | 8687 | NV |
NPI | 1023051760 |
---|---|
Provider Name | Timothy Vanduzer |
First Address | Henderson, NV 89012-3226 |
Second Address | Las Vegas, NV 89107-1082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G70540 | (02) |