Provider Demographics
NPI:1083030431
Name:JORAM S. SEGGEV, MD, CHTD
Entity Type:Organization
Organization Name:JORAM S. SEGGEV, MD, CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-822-2444
Mailing Address - Street 1:7500 W LAKE MEAD BLVD # C9-292
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0297
Mailing Address - Country:US
Mailing Address - Phone:702-822-2444
Mailing Address - Fax:702-242-0655
Practice Address - Street 1:3150 N TENAYA WAY STE 515
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0448
Practice Address - Country:US
Practice Address - Phone:702-822-2444
Practice Address - Fax:702-242-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6303207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019171Medicaid
NVA28293Medicare UPIN