MEDICARE: ISAAC B. TUNNELL P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0160	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164670634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC B. TUNNELL P.A.

Provider Business Mailing Address
First Line	:	6120 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-948-8660
Fax Number	:	702-483-6663

Provider Business Practice Location Address
First Line	:	6120 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-948-8660
Fax Number	:	702-483-6663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	12/03/2018

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