MEDICARE: MR. JAMES C SOMERS MS, PA-C, DFAAPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA658	NV

General Provider Information

NPI Number	:	1003985912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES C SOMERS MS, PA-C, DFAAPA

Provider Business Mailing Address
First Line	:	3315 E RUSSELL RD
Second Line	:	SUITE A-4 #410
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3459
Country	:	US
Telephone Number	:	702-522-9455
Fax Number	:	702-522-9227

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD
Second Line	:	SUITE #205
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	702-217-8030
Fax Number	:	702-537-5736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/25/2014

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