MEDICARE: NEVADA PRIMARY PHYSICIANS GROUP NATH 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	207R00000X	Internal Medicine Physician	8705	NV

General Provider Information

NPI Number	:	1386021590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PRIMARY PHYSICIANS GROUP NATH MD

Provider Business Mailing Address
First Line	:	3590 ALPINE LILY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3590 ALPINE LILY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3251
Country	:	US
Telephone Number	:	702-460-6360
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANOJ NATH
Credential	:	MD
Telephone Number	:	702-460-6360

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	06/17/2015

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