Provider Demographics
NPI:1396056628
Name:SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SEIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-304-1911
Mailing Address - Street 1:1350 E FLAMINGO RD
Mailing Address - Street 2:#3330
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5263
Mailing Address - Country:US
Mailing Address - Phone:702-304-1911
Mailing Address - Fax:702-304-2611
Practice Address - Street 1:8930 W SUNSET RD
Practice Address - Street 2:#350
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5008
Practice Address - Country:US
Practice Address - Phone:702-304-1911
Practice Address - Fax:702-304-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV44210207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002004212Medicaid
NVEB474AOtherMEDICARE PTAN