1720324429 NPI number — ELMER S. DAVID, MD, PLLC

Table of content: (NPI 1720324429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720324429 NPI number — ELMER S. DAVID, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELMER S. DAVID, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
A LAS VEGAS MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720324429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5876 S. PECOS RD. BLDG. B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-733-0744
Provider Business Mailing Address Fax Number:
702-796-8262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5876 S. PECOS RD. BLDG. B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-733-0744
Provider Business Practice Location Address Fax Number:
702-796-8262
Provider Enumeration Date:
12/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALAXECHEVARRIA
Authorized Official First Name:
NIKOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
702-733-0744

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1091 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 14165 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: 25MA05800100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN001848 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5234409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".