Healthcare Provider Details

I. General information

NPI: 1780662817
Provider Name (Legal Business Name): TROY SHANNUN WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

IV. Provider business mailing address

2800 E DESERT INN RD STE 100
LAS VEGAS NV
89121-3609
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1616
  • Fax: 702-734-4900
Mailing address:
  • Phone: 702-731-1616
  • Fax: 702-734-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number9363
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: