Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 6466 | NV |
NPI | 1194714030 |
---|---|
Provider Name | Mr. Mark Bradley Kabins |
First Address | Las Vegas, NV 89106-4828 |
Second Address | Las Vegas, NV 89106-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 24/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100504174 | (05) | NV |
E94199 | (02) |