Provider Demographics
NPI:1447576806
Name:ELTGROTH, MATTHEW LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LOUIS
Last Name:ELTGROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2434 GREENS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3778
Mailing Address - Country:US
Mailing Address - Phone:530-228-5771
Mailing Address - Fax:
Practice Address - Street 1:7130 SMOKE RANCH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:877-406-2916
Practice Address - Fax:864-797-6389
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV163382085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology