Provider Demographics
NPI:1275568883
Name:ETEBAR, RAMIN (MD LTD)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:ETEBAR
Suffix:
Gender:M
Credentials:MD LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-671-6595
Practice Address - Street 1:525 MARKS ST.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-383-6210
Practice Address - Fax:702-435-7050
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019316Medicaid
F64834Medicare UPIN
NV002019316Medicaid