Provider Demographics
NPI:1346513108
Name:ASCAR EGTEDAR MD INC
Entity Type:Organization
Organization Name:ASCAR EGTEDAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:EGTEDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-878-9444
Mailing Address - Street 1:2601 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2153
Mailing Address - Country:US
Mailing Address - Phone:702-878-9444
Mailing Address - Fax:702-878-9565
Practice Address - Street 1:2601 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2153
Practice Address - Country:US
Practice Address - Phone:702-878-9444
Practice Address - Fax:702-878-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3055207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE01217Medicare UPIN