Provider Demographics
NPI:1790896660
Name:JAUSSI, WALTER REED (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:REED
Last Name:JAUSSI
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 1:5840 W CRAIG RD
Mailing Address - Street 2:STE. 120 PMB 254
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2561
Mailing Address - Country:US
Mailing Address - Phone:702-724-2020
Mailing Address - Fax:702-405-5541
Practice Address - Street 1:5871 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2575
Practice Address - Country:US
Practice Address - Phone:702-724-2020
Practice Address - Fax:702-724-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49198431205207W00000X
NV14252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87667Medicare UPIN
000012513Medicare PIN
UT4547560001Medicare NSC