MEDICARE: GOLAN INTEGRATED PHYSICAL MEDICINE

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6983960001	OTHER	NV	PTAN

General Provider Information

NPI Number	:	1497195580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLAN INTEGRATED PHYSICAL MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 561564
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80256-1564
Country	:	US
Telephone Number	:	702-202-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	6592 N DECATUR BLVD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1037
Country	:	US
Telephone Number	:	702-478-9594
Fax Number	:	702-478-9509

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DAVID ROBERT GOLAN
Credential	:	MD
Telephone Number	:	808-463-9726

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	04/25/2022

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Directions to “GOLAN INTEGRATED PHYSICAL MEDICINE ” Practice Location

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