1851553572 NPI number — WADE R GAAL M.D.

Table of content: WADE R GAAL M.D. (NPI 1851553572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851553572 NPI number — WADE R GAAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAAL
Provider First Name:
WADE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851553572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 W. CHARLESTON BLVD.,SUITE 670
Provider Second Line Business Mailing Address:
ATTN: SANDRA EROSA, CREDENTIALING SPECIALIST
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-2355
Provider Business Mailing Address Fax Number:
702-382-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5380 S RAINBOW BLVD STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89118-1880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-405-8150
Provider Business Practice Location Address Fax Number:
702-405-8116
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , with the licence number:  14059 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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