Provider Demographics
NPI:1255305520
Name:FAJARDO, NOEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:R
Last Name:FAJARDO
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 1:7315 S. PECOS ROAD
Mailing Address - Street 2:STE. 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-982-7240
Mailing Address - Fax:702-586-7506
Practice Address - Street 1:3901 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7537
Practice Address - Country:US
Practice Address - Phone:702-982-7240
Practice Address - Fax:702-586-7506
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44964207RG0100X
NV12053207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511073Medicaid
MN341790500Medicaid
MN341790500Medicaid
NV103468Medicare PIN
MN100000478Medicare ID - Type Unspecified
H59904Medicare UPIN