Provider Demographics
NPI:1629546585
Name:REUBEN I THAKER MD PLLC
Entity type:Organization
Organization Name:REUBEN I THAKER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-545-0660
Mailing Address - Street 1:9420 W SAHARA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8800
Mailing Address - Country:US
Mailing Address - Phone:702-545-0660
Mailing Address - Fax:253-461-7851
Practice Address - Street 1:9420 W SAHARA AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8800
Practice Address - Country:US
Practice Address - Phone:702-545-0660
Practice Address - Fax:253-461-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881890432Medicaid