Provider Demographics
NPI:1255375838
Name:HUCK, ELIZABETH L (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:HUCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7241 W SAHARA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2858
Mailing Address - Country:US
Mailing Address - Phone:702-254-5004
Mailing Address - Fax:702-432-4005
Practice Address - Street 1:8530 W SUNSET RD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2215
Practice Address - Country:US
Practice Address - Phone:702-254-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO20042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G65780Medicare UPIN
K26105Medicare ID - Type Unspecified