Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DO2246 | NV |
NPI | 1134506793 |
---|---|
Provider Name | Glenn Barnes |
First Address | Las Vegas, NV 89106-4194 |
Second Address | Las Vegas, NV 89106-4194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 24/02/2020 |