Provider Demographics
NPI:1144270349
Name:LUSS, ROSNER PATRICK (MD)
Entity type:Individual
Prefix:
First Name:ROSNER
Middle Name:PATRICK
Last Name:LUSS
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 1:1621 E FLAMINGO RD
Mailing Address - Street 2:B-16
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5276
Mailing Address - Country:US
Mailing Address - Phone:702-696-0506
Mailing Address - Fax:702-696-0532
Practice Address - Street 1:1621 E FLAMINGO RD
Practice Address - Street 2:B-16
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5276
Practice Address - Country:US
Practice Address - Phone:702-696-0506
Practice Address - Fax:702-696-0532
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ964206OtherMCAID
NV29D2033945OtherCLIA
NV002018068Medicaid
NV002018068Medicaid
AZ964206OtherMCAID