Provider Demographics
NPI:1376516104
Name:STECKLER, THERESA L (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:STECKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 PRAIRIE FALCON RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0807
Mailing Address - Country:US
Mailing Address - Phone:702-792-4336
Mailing Address - Fax:702-384-6411
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-243-7483
Practice Address - Fax:702-838-1247
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV6730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019246Medicaid
NVV30666OtherMEDICARE GROUP
NVV24262OtherLAB
NVF20430Medicare UPIN
NV63971Medicare PIN