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NPI Code Detail

MEDICARE: DR. MERVYN BRUCE FOUSE M.D.

MEDICARE: DR. MERVYN BRUCE FOUSE M.D.
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician5401NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3200006951OTHERR.R. MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NV8839OTHERBXBS
44294880OTHERAETNA

General Provider Information

NPI Number : 1598743916
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MERVYN BRUCE FOUSE M.D.
Provider Business Mailing Address
First Line : PO BOX 50509
Second Line :
City : HENDERSON
State : NV
Zip : 89016-0509
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-731-0741
Provider Business Practice Location Address
First Line : 2800 E DESERT INN RD
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89121-3608
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-731-0741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 03/15/2012

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