Provider Demographics
NPI:1871753046
Name:SEIFZAD, BEN (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:SEIFZAD
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 1:10040 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 170-91
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7719
Mailing Address - Country:US
Mailing Address - Phone:702-525-9309
Mailing Address - Fax:
Practice Address - Street 1:10040 W CHEYENNE AVE
Practice Address - Street 2:SUITE 170-91
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7719
Practice Address - Country:US
Practice Address - Phone:702-525-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13282207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871753046Medicaid
NVCP677ZMedicare PIN