Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 705 | NV |
NPI | 1215917042 |
---|---|
Provider Name | David D Moon |
First Address | Las Vegas, NV 89145-0373 |
Second Address | Las Vegas, NV 89145-0373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E93416 | (02) | NV |