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NPI Code Detail

MEDICARE: MR. STANLEY DWAYNE SMALL

MEDICARE: MR. STANLEY DWAYNE SMALL
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
1101Y00000XCounselor101Y00000XNV

General Provider Information

NPI Number : 1831357623
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STANLEY DWAYNE SMALL
Provider Business Mailing Address
First Line : 5615 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1961
Country : US
Telephone Number : 702-736-8100
Fax Number :
Provider Business Practice Location Address
First Line : 5615 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-1961
Country : US
Telephone Number : 702-736-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2008
Last Update Date : 05/28/2008

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Directions to “ MR. STANLEY DWAYNE SMALL ” Practice Location

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