Provider Demographics
NPI:1104816214
Name:MUKHOPADHYAY, DEB K (MD)
Entity type:Individual
Prefix:
First Name:DEB
Middle Name:K
Last Name:MUKHOPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33907
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3907
Mailing Address - Country:US
Mailing Address - Phone:702-233-0666
Mailing Address - Fax:702-233-8176
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE #604
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-233-0666
Practice Address - Fax:702-233-8176
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH09362Medicare UPIN