Provider Demographics
NPI:1164626198
Name:JESUS F. TIRAO, M.D. LTD
Entity Type:Organization
Organization Name:JESUS F. TIRAO, M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:F
Authorized Official - Last Name:TIRAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-733-9000
Mailing Address - Street 1:3585 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3344
Mailing Address - Country:US
Mailing Address - Phone:702-733-9000
Mailing Address - Fax:
Practice Address - Street 1:3585 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3344
Practice Address - Country:US
Practice Address - Phone:702-733-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102073Medicare ID - Type Unspecified