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General NPI Number Information
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NPI Number | 1629058805
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Entity Type | Individual
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Provider Name | KANE MATTHEW DEEM PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1511 GRANT AVE
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City | GARDNERVILLE
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State | NV
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Zip | 89410-7824
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Country | US
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Telephone | 775-445-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 SOUTH CURRY STREET SUITE 100
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City | CARSON CITY
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State | NV
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Zip | 89703
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Country | US
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Telephone | 775-883-3336
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Fax | 775-883-0877
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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