Provider Demographics
NPI:1295967784
Name:ROSNER P. LUSS MD LTD
Entity type:Organization
Organization Name:ROSNER P. LUSS MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSNER
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-696-0506
Mailing Address - Street 1:1621 E FLAMINGO RD
Mailing Address - Street 2:16B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5276
Mailing Address - Country:US
Mailing Address - Phone:702-696-0506
Mailing Address - Fax:702-696-0532
Practice Address - Street 1:1621 E FLAMINGO RD
Practice Address - Street 2:16B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5276
Practice Address - Country:US
Practice Address - Phone:702-696-0506
Practice Address - Fax:702-696-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8699173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV29D2033945OtherCLIA
AZ964206OtherMEDICAID
NV002018068Medicaid
AZ964206OtherMEDICAID
NVCP581ZMedicare PIN