Provider Demographics
NPI:1457415663
Name:ARNOLD WAX MD LTD
Entity Type:Organization
Organization Name:ARNOLD WAX MD LTD
Other - Org Name:ARNOLD WAX MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-897-5283
Mailing Address - Street 1:2245 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-5024
Mailing Address - Country:US
Mailing Address - Phone:702-897-5283
Mailing Address - Fax:702-949-0827
Practice Address - Street 1:3509 E HARMON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5028
Practice Address - Country:US
Practice Address - Phone:702-547-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5552207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96685Medicare UPIN
NVV103210Medicare PIN