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Contact Information

STEPHEN J IACOBONI, MD
3006 S MARYLAND PKWY STE 205
LAS VEGAS, NV89109
 Phone: 702-735-7154
 Fax: 702-735-7153
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical Oncology

207RX0202X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for STEPHEN J IACOBONI · (Male)

NPI Number 1497706162
Status Active
Credentials MD
Entity Individual
Enumeration date 05/15/2006
Last updated 05/18/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M8193
  • WA License # MD00024072
  • ID Medicaid 805994300
  • NV Medicaid 1497706162
  • WA Medicaid 1497706162
  • NV Other 15296 STATE LICENSE
Hospital affiliation(s)
  • GOOD SHEPHERD MEDICAL CENTER - (Critical Access)
    610 NW 11TH STREET
    HERMISTON, OR 97838
  • KADLEC REGIONAL MEDICAL CENTER - (Acute Care)
    888 SWIFT BLVD
    RICHLAND, WA 99352
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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