Basic Information
| Provider Information | |||||||||
| NPI: | 1447576806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELTGROTH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50709 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890160709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774062916 | ||||||||
| FaxNumber: | 8647976389 | ||||||||
| Practice Location | |||||||||
| Address1: | 7130 SMOKE RANCH RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891283157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774062916 | ||||||||
| FaxNumber: | 8647976389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2010 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 16338 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.