Provider Demographics
NPI:1699146373
Name:DAULAT MEDICAL CENTER
Entity type:Organization
Organization Name:DAULAT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAULAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-565-4917
Mailing Address - Street 1:7106 SMOKE RANCH RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8306
Mailing Address - Country:US
Mailing Address - Phone:702-565-4917
Mailing Address - Fax:702-562-8680
Practice Address - Street 1:7106 SMOKE RANCH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8306
Practice Address - Country:US
Practice Address - Phone:702-565-4917
Practice Address - Fax:702-562-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP0083737OtherRAILROAD MEDICARE
NV1295709418Medicaid
NVP0083737OtherRAILROAD MEDICARE