Healthcare Provider Details

I. General information

NPI: 1861432924
Provider Name (Legal Business Name): KEVIN M DINWIDDIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ERRECART BLVD SUITE 201
ELKO NV
89801-8334
US

IV. Provider business mailing address

1995 ERRECART BLVD SUITE 201
ELKO NV
89801-8334
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-4477
  • Fax: 775-738-5199
Mailing address:
  • Phone: 775-738-4477
  • Fax: 775-738-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4767
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: