Provider Demographics
NPI:1194132811
Name:DALRYMPLE, WILLIAM IV (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DALRYMPLE
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MARTIN LUTHER KING BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4325
Mailing Address - Country:US
Mailing Address - Phone:725-228-4500
Mailing Address - Fax:877-889-2823
Practice Address - Street 1:80 S MARTIN LUTHER KING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4325
Practice Address - Country:US
Practice Address - Phone:725-228-4500
Practice Address - Fax:877-889-2823
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2251207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194132811Medicaid
NVV73243OtherMEDICARE