MEDICARE: PATRICIA PRINCE MD

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	6010	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V112706	OTHER	NV	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144259813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA PRINCE MD

Provider Business Mailing Address
First Line	:	PO BOX 36310
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6310
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

Provider Business Practice Location Address
First Line	:	2481 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0825
Country	:	US
Telephone Number	:	702-382-1599
Fax Number	:	702-240-4962

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/21/2022

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Directions to “ PATRICIA PRINCE MD” Practice Location

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