Provider Demographics
NPI:1528122777
Name:EDEN, TROY (PA)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:EDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:700 E SILVERADO RANCH BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7518
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-804-0957
Practice Address - Street 1:762 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3413
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-240-8529
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105503OtherTROY'S PTAN
NVV105461OtherEDEN MEDICAL PTAN
NVP00743822Medicare PIN
NVV105461OtherEDEN MEDICAL PTAN