Provider Demographics
NPI:1558368431
Name:VIRGIL, CARL D (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:D
Last Name:VIRGIL
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 1:10120 S EASTERN AVE #130
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-487-6800
Mailing Address - Fax:702-473-5455
Practice Address - Street 1:9260 W SUNSET RD
Practice Address - Street 2:STE. 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4858
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-921-2419
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8069207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002577Medicaid
38400Medicare ID - Type Unspecified
NVG15003Medicare UPIN
G15003Medicare UPIN
NV2002577Medicaid