Provider Demographics
NPI:1043440514
Name:JOAQUIM S TAVARES MD PC
Entity Type:Organization
Organization Name:JOAQUIM S TAVARES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAQUIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-380-1944
Mailing Address - Street 1:PO BOX 80624
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-0624
Mailing Address - Country:US
Mailing Address - Phone:702-380-1944
Mailing Address - Fax:
Practice Address - Street 1:1711 SONGLIGHT CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1584
Practice Address - Country:US
Practice Address - Phone:702-380-1944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9087207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9087OtherMEDICAL LICENSE
NVH05902Medicare UPIN