Provider Demographics
NPI:1487741922
Name:FERRER, CONRADO D (PAC)
Entity type:Individual
Prefix:MR
First Name:CONRADO
Middle Name:D
Last Name:FERRER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 CRUZ BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7284
Mailing Address - Country:US
Mailing Address - Phone:702-280-2240
Mailing Address - Fax:
Practice Address - Street 1:4100 W FLAMINGO ROAD
Practice Address - Street 2:SUITE 2100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103
Practice Address - Country:US
Practice Address - Phone:702-822-5000
Practice Address - Fax:702-822-5001
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV109363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P79908Medicare UPIN
37156Medicare ID - Type Unspecified