Provider Demographics
NPI:1922147354
Name:FLOTH, PHILIP (CST)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:FLOTH
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 BAYCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-3633
Mailing Address - Country:US
Mailing Address - Phone:702-558-7823
Mailing Address - Fax:702-558-9743
Practice Address - Street 1:1325 BAYCHESTER DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-3633
Practice Address - Country:US
Practice Address - Phone:702-558-7823
Practice Address - Fax:702-558-9743
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO050242246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist