Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 9082 | NV |
N | 2080P0204X | Pediatric Emergency Doctor | G077747 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | G77747 | CA |
NPI | 1174663066 |
---|---|
Provider Name | David Nelson |
First Address | Las Vegas, NV 89102-2329 |
Second Address | Las Vegas, NV 89102-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 22/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2018320 | (05) | NV |
G23418 | (02) |