Provider Demographics
NPI:1750354239
Name:TOMASIC, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TOMASIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 W SUNSET RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4858
Mailing Address - Country:US
Mailing Address - Phone:702-255-3547
Mailing Address - Fax:702-921-2419
Practice Address - Street 1:9260 W SUNSET RD STE 207
Practice Address - Street 2:STE. 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-304-5756
Practice Address - Fax:702-906-0933
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11487207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506633Medicaid
NV100506632Medicaid
NV1750354239Medicaid
NVVWCHKLOtherNORIDIAN
NV100500023OtherNV MEDICAID
NV1750354239Medicaid
NVV112544Medicare PIN
I28176Medicare UPIN