Basic Information
Provider Information
NPI: 1750598165
EntityType: 2
ReplacementNPI:  
OrganizationName: DAVID VANSOMPHONE MD LTD
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Mailing Information
Address1: PO BOX 35984
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891335984
CountryCode: US
TelephoneNumber: 7025971597
FaxNumber:  
Practice Location
Address1: 5375 S FORT APACHE RD
Address2: SUITE 101
City: LAS VEGAS
State: NV
PostalCode: 891487623
CountryCode: US
TelephoneNumber: 7025971597
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2007
LastUpdateDate: 05/17/2010
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AuthorizedOfficialLastName: LABRECQUE
AuthorizedOfficialFirstName: LORI
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AuthorizedOfficialTitleorPosition: ACCTS. MGR
AuthorizedOfficialTelephone: 7024533799
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X9448NVY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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