Basic Information
| Provider Information | |||||||||
| NPI: | 1154307635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEPHARDT | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3157 N RAINBOW BLVD # 518 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891084578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 S CIMARRON RD STE 270 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891132160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029124100 | ||||||||
| FaxNumber: | 7029124101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4992 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 46286 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 4992 | NV | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 4992 | NV | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 4992 | NV | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002002813 | 05 | NV | MEDICAID |