Provider Demographics
NPI:1588702062
Name:MENDENHALL, DAVID REYNOLDS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REYNOLDS
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:STE. F-41
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-384-3200
Mailing Address - Fax:702-384-5276
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:STE. F-41
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-384-3200
Practice Address - Fax:702-384-5276
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVMD2741Medicare ID - Type Unspecified
NVC96339Medicare UPIN