Provider Demographics
NPI:1578561650
Name:SELTZER, LAURIE SUSAN (DO)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUSAN
Last Name:SELTZER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6231
Mailing Address - Country:US
Mailing Address - Phone:702-990-6900
Mailing Address - Fax:702-702-3078
Practice Address - Street 1:1000 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-990-6900
Practice Address - Fax:702-702-3078
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ877962Medicaid
NV38044Medicare ID - Type Unspecified
AZ877962Medicaid
NVP00065460Medicare ID - Type Unspecified
NVP00088222Medicare ID - Type Unspecified
NV38043Medicare ID - Type Unspecified