Provider Demographics
NPI:1790811396
Name:FEIKES, J RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:RANDALL
Last Name:FEIKES
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 1:5320 S RAINBOW BLVD
Mailing Address - Street 2:STE 282
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1895
Mailing Address - Country:US
Mailing Address - Phone:702-737-3808
Mailing Address - Fax:702-737-0154
Practice Address - Street 1:5320 S RAINBOW BLVD
Practice Address - Street 2:STE 282
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1895
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:702-737-0154
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8749208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-18050Medicaid
NV31180Medicare ID - Type Unspecified
NV20-18050Medicaid