Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 8902 | NV |
Y | 222Z00000X | Podiatrist | 8902 | NV |
NPI | 1013988997 |
---|---|
Provider Name | Jon James |
First Address | Las Vegas, NV 89114-5645 |
Second Address | Las Vegas, NV 89102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 14/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013988997 | (05) | NV |
2102794 | (05) | NV |
T66697 | (02) |