Healthcare Provider Details

I. General information

NPI: 1053525485
Provider Name (Legal Business Name): DAVID R. MENDENHALL M.D., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR SUITE F-41
LAS VEGAS NV
89106-4828
US

IV. Provider business mailing address

501 S RANCHO DR SUITE F-41
LAS VEGAS NV
89106-4828
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-3200
  • Fax: 702-384-5276
Mailing address:
  • Phone: 702-384-3200
  • Fax: 702-384-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2741
License Number StateNV

VIII. Authorized Official

Name: DR. DAVID REYNOLDS MENDENHALL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-384-3200