Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 5819 | NV |
NPI | 1003819749 |
---|---|
Provider Name | Berge Jack Dadourian |
First Address | Las Vegas, NV 89145-5721 |
Second Address | Las Vegas, NV 89145-5721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2005 |
Last Update Date | 04/02/2015 |