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NPI Code Detail

MEDICARE: DR. TIERNEY LYNNE TIREY M.D.

MEDICARE: DR. TIERNEY LYNNE TIREY M.D.
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
1208D00000XGeneral Practice Physician5410NV

Other Identifiers

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

General Provider Information

NPI Number : 1710102991
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIERNEY LYNNE TIREY M.D.
Provider Business Mailing Address
First Line : 1825 CIVIC CENTER DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7113
Country : US
Telephone Number : 702-642-8313
Fax Number : 702-642-8903
Provider Business Practice Location Address
First Line : 1825 CIVIC CENTER DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7113
Country : US
Telephone Number : 702-642-8313
Fax Number : 702-642-8903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2007
Last Update Date : 07/08/2007

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