1841528882 NPI number — DWAYNE THURMOND LMT,MCTMB,NCMA,CMCP

Table of content: DWAYNE THURMOND LMT,MCTMB,NCMA,CMCP (NPI 1841528882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841528882 NPI number — DWAYNE THURMOND LMT,MCTMB,NCMA,CMCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURMOND
Provider First Name:
DWAYNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT,MCTMB,NCMA,CMCP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1841528882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9353 W TWAIN AVE
Provider Second Line Business Mailing Address:
APT. 185
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89147-6861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
STE. 21
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89145-5362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-880-4325
Provider Business Practice Location Address Fax Number:
702-870-2889
Provider Enumeration Date:
12/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  NVMT.3065 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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