Provider Demographics
NPI:1194714030
Name:KABINS, MARK BRADLEY (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:BRADLEY
Last Name:KABINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:SUITE I-67
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-243-4700
Mailing Address - Fax:702-243-7074
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE I-67
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-243-4700
Practice Address - Fax:702-243-7074
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6466207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504174Medicaid
NV39656Medicare ID - Type Unspecified
NV100504174Medicaid