Provider Demographics
NPI:1447214564
Name:DOUBRAVA, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:DOUBRAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:DIAB
Other - Last Name:DOUBRAVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9011 W SAHARA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4800
Mailing Address - Country:US
Mailing Address - Phone:702-794-2020
Mailing Address - Fax:702-732-4108
Practice Address - Street 1:9011 W SAHARA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4800
Practice Address - Country:US
Practice Address - Phone:702-794-2020
Practice Address - Fax:702-732-4108
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071917207W00000X
NV7190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019869Medicaid
NVVMD7190Medicare PIN
NVG41731Medicare UPIN
NV002019869Medicaid