Basic Information
| Provider Information | |||||||||
| NPI: | 1457732760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 W CHARLESTON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027807118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1707 W CHARLESTON BLVD STE 160 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026715150 | ||||||||
| FaxNumber: | 7023846493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | DO2732 | NV | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | DO2732 | NV | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0102X | DO2732 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.