Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 828 | NV |
Y | 207Q00000X | Family Doctor | 828 | NV |
NPI | 1134146111 |
---|---|
Provider Name | Dr. Pejman Bady |
First Address | Pahrump, NV 89041-6255 |
Second Address | Las Vegas, NV 89148-5622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134146111 | (05) | NV |
P00870033 | RAILROAD MEDICARE (01) | NV |