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NPI Code Detail

MEDICARE: ALLEN ALVA ERISMAN D.O.

MEDICARE: ALLEN ALVA ERISMAN D.O.
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
1207P00000XEmergency Medicine Physician1135NV
2207PE0004XEmergency Medical Services (Emergency Medicine) Physician1135NV
3207P00000XEmergency Medicine Physician02002084AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC7823OTHERNVBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245233485
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLEN ALVA ERISMAN D.O.
Provider Business Mailing Address
First Line : 9229 LBJ FWY
Second Line : STE 250
City : DALLAS
State : TX
Zip : 75243-3405
Country : US
Telephone Number : 800-346-0747
Fax Number : 972-739-2638
Provider Business Practice Location Address
First Line : 3100 N TENAYA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0436
Country : US
Telephone Number : 972-915-3600
Fax Number : 972-915-3636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 10/01/2014

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Directions to “ ALLEN ALVA ERISMAN D.O.” Practice Location

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