Provider Demographics
NPI:1306028014
Name:LALLY, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LALLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-384-0022
Mailing Address - Fax:702-384-0529
Practice Address - Street 1:700 SHADOW LN.
Practice Address - Street 2:SUITE 240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4158
Practice Address - Country:US
Practice Address - Phone:702-384-0022
Practice Address - Fax:702-384-0529
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2022-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV12809207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100515393Medicaid