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General NPI Number Information
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NPI Number | 1417080839
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1707 W CHARLESTON BLVD 110B
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City | LAS VEGAS
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State | NV
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Zip | 89102-2351
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Country | US
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Telephone | 702-968-4363
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Fax | 702-671-0193
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Provider Business Mailing Address
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Address Line | PO BOX 29506
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City | LAS VEGAS
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State | NV
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Zip | 89126-9506
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Country | US
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Telephone | 702-968-4371
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Fax | 702-671-5170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISSA J PALMER
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Credential | MD
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Telephone | 702-992-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0202X
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Taxonomy Name | Clinical Biochemical Genetics Physician
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License Number |
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Taxonomy #2
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 207SG0205X
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Taxonomy Name | Ph.D. Medical Genetics Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 207SM0001X
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Taxonomy Name | Molecular Genetic Pathology (Medical Genetics) Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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Taxonomy #6
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Taxonomy Code | 207SC0300X
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Taxonomy Name | Clinical Cytogenetics Physician
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License Number |
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