Provider Demographics
NPI:1437584950
Name:UDELL, ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:UDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7391 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1577
Mailing Address - Country:US
Mailing Address - Phone:702-304-2144
Mailing Address - Fax:702-304-2147
Practice Address - Street 1:7391 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1577
Practice Address - Country:US
Practice Address - Phone:702-304-2144
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13062207R00000X
NVDO2039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014372300Medicaid
FLIC429YMedicare PIN