Provider Demographics
NPI:1225010523
Name:SEGGEV, JORAM S (MD)
Entity Type:Individual
Prefix:
First Name:JORAM
Middle Name:S
Last Name:SEGGEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 W LAKE MEAD BLVD
Mailing Address - Street 2:C9-292
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 1:7500 W LAKE MEAD BLVD
Practice Address - Street 2:C9-292
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0297
Practice Address - Country:US
Practice Address - Phone:702-822-2444
Practice Address - Fax:702-242-0655
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6303207K00000X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS414Medicare PIN