Provider Demographics
NPI: | 1245343037 |
---|---|
Name: | DOCASAR, HAYDEE B (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HAYDEE |
Middle Name: | B |
Last Name: | DOCASAR |
Suffix: | |
Gender: | F |
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: | 8255 LAS VEGAS BLVD S UNIT 309 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89123-1067 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-301-2111 |
Mailing Address - Fax: | 855-898-8685 |
Practice Address - Street 1: | 6070 S FORT APACHE RD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89148-5615 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-550-4870 |
Practice Address - Fax: | 855-898-8685 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-08-16 |
Last Update Date: | 2024-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 10887 | 207VG0400X, 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | V104021 | Medicaid | |
NV | 100502389 | Medicaid | |
NV | 100502389 | Medicaid |