Provider Demographics
NPI:1477647170
Name:EHRENFELD, HOWARD D (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:D
Last Name:EHRENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:4475 S EASTERN AVENUE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-669-5944
Mailing Address - Fax:702-737-5088
Practice Address - Street 1:4475 S EASTERN AVE
Practice Address - Street 2:NEUROLOGY CLINIC
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7826
Practice Address - Country:US
Practice Address - Phone:702-669-5944
Practice Address - Fax:702-737-5088
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0365242084N0400X
NV121142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1477647170Medicaid
NV100511183Medicaid
E86135Medicare UPIN
NV100511183Medicaid