Provider Demographics
NPI:1962483073
Name:KANTOR, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:KANTOR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1750 E DESERT INN RD
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-3202
Mailing Address - Country:US
Mailing Address - Phone:702-732-2438
Mailing Address - Fax:702-734-7006
Practice Address - Street 1:1750 E DESERT INN RD
Practice Address - Street 2:#200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3202
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-734-7006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2607207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96206Medicare UPIN
39WCGWM03Medicare ID - Type Unspecified