MEDICARE: JAMES CLEVELAND III

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	207Q00000X	Family Medicine Physician	CHW1-5466	NV

General Provider Information

NPI Number	:	1083488555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES CLEVELAND III

Provider Business Mailing Address
First Line	:	800 N RAINBOW BLVD STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1191
Country	:	US
Telephone Number	:	702-213-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 N RAINBOW BLVD STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1191
Country	:	US
Telephone Number	:	702-213-0007
Fax Number	:

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	10/11/2024

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