Healthcare Provider Details

I. General information

NPI: 1033385307
Provider Name (Legal Business Name): CHARLIE NAHM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 W SUNSET RD STE A
LAS VEGAS NV
89148-4845
US

IV. Provider business mailing address

9333 W SUNSET RD STE A
LAS VEGAS NV
89148-4845
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-6259
  • Fax: 702-987-3219
Mailing address:
  • Phone: 702-968-6259
  • Fax: 702-987-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA70052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16636
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: