Provider Demographics
NPI:1881863538
Name:ADVANCED MEDICAL WEIGHT
Entity Type:Organization
Organization Name:ADVANCED MEDICAL WEIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:702-897-9797
Mailing Address - Street 1:76 W HORIZON RIDGE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012
Mailing Address - Country:US
Mailing Address - Phone:702-897-9797
Mailing Address - Fax:702-897-9795
Practice Address - Street 1:76 W HORIZON RIDGE
Practice Address - Street 2:SUITE 125
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012
Practice Address - Country:US
Practice Address - Phone:702-897-9797
Practice Address - Fax:702-897-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty