Provider Demographics
NPI:1083870554
Name:JOSEPH, SAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJU
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2435 FIRE MESA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:725-200-3242
Mailing Address - Fax:702-664-6762
Practice Address - Street 1:5380 S RAINBOW BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-853-3300
Practice Address - Fax:702-563-3390
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV174122086X0206X
TX444472086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308005Medicaid
LA4N412Medicare PIN
LA1308005Medicaid