Provider Demographics
NPI:1063466027
Name:NUNES, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:NUNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:10170 W TROPICANA AVE STE 156-252
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8465
Mailing Address - Country:US
Mailing Address - Phone:702-732-1493
Mailing Address - Fax:702-732-1080
Practice Address - Street 1:1 BREAKTHROUGH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3011
Practice Address - Country:US
Practice Address - Phone:702-732-1493
Practice Address - Fax:702-732-1080
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73873207SG0203X, 208000000X, 207SG0201X
OH35087252208000000X, 207SG0201X, 207SG0203X
NV26479207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2623058Medicaid
OHNU4177671Medicare ID - Type UnspecifiedOHIO MEDICARE
OH2623058Medicaid