Healthcare Provider Details

I. General information

NPI: 1144490343
Provider Name (Legal Business Name): UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MULTI-SPECIALTY GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RANCHO LN 205
LAS VEGAS NV
89106-3836
US

IV. Provider business mailing address

PO BOX 29506
LAS VEGAS NV
89126-9506
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2810
  • Fax: 702-944-2820
Mailing address:
  • Phone: 702-968-4371
  • Fax: 702-671-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: ELISSA J PALMER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-992-6888