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NPI Code Detail

MEDICARE: DR. JUSTIN CHARLES DE LANNOY MD

MEDICARE: DR. JUSTIN CHARLES DE LANNOY 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
1207R00000XInternal Medicine Physician20116NV
2208M00000XHospitalist Physician20116NV
3390200000XStudent in an Organized Health Care Education/Training Program
4207R00000XInternal Medicine PhysicianDR.0065143CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1029147OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1750815080
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN CHARLES DE LANNOY MD
Provider Business Mailing Address
First Line : 6900 N PECOS RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-4400
Country : US
Telephone Number : 702-791-9000
Fax Number :
Provider Business Practice Location Address
First Line : 6900 N PECOS RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-4400
Country : US
Telephone Number : 702-791-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2017
Last Update Date : 03/13/2026

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