Provider Demographics
NPI:1992722474
Name:VONTOBEL, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VONTOBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 S MARYLAND PKWY 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2302
Mailing Address - Country:US
Mailing Address - Phone:702-320-3627
Mailing Address - Fax:702-320-3849
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-869-9200
Practice Address - Fax:702-216-3821
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002200Medicaid
NVV107573Medicare PIN
C96669Medicare UPIN
NV30566Medicare ID - Type Unspecified