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General NPI Number Information
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NPI Number | 1255429841
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Entity Type | Individual
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Provider Name | DENNIS JAMES FIVECOAT PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4511 W CHEYENNE AVE STE 700
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-2450
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Country | US
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Telephone | 702-643-4279
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Fax | 702-643-4282
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Provider Business Mailing Address
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Address Line | 2451 N RAINBOW BLVD #1125
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City | LAS VEGAS
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State | NV
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Zip | 89108-4502
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Country | US
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Telephone | 702-645-4469
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Fax | 702-643-4282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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