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General NPI Number Information
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NPI Number | 1588797146
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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 | 03/13/2007
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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 220
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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 | 702-671-5070
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Fax | 702-671-5072
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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Taxonomy #8
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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