Provider Demographics
NPI:1609854462
Name:HOROWITZ, ELIOT M (MD)
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:M
Last Name:HOROWITZ
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 1:7150 W. SUNSET RD.
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1982
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:9053 S. PECOS RD.
Practice Address - Street 2:SUITE 2900
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7178
Practice Address - Country:US
Practice Address - Phone:702-735-8000
Practice Address - Fax:702-735-4795
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5359208800000X
CAG49150208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002775Medicaid
CADE793YOtherMEDICARE PTAN FOR GENESIS HEALTHCARE PARTNERS, SAN DIEGO CA
CADE793YOtherMEDICARE PTAN FOR GENESIS HEALTHCARE PARTNERS, SAN DIEGO CA