Provider Demographics
NPI:1346311354
Name:CADE, JERRY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LYNN
Last Name:CADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 CAPISTRANO AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2281
Mailing Address - Country:US
Mailing Address - Phone:702-203-8022
Mailing Address - Fax:
Practice Address - Street 1:2300 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 265
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2149
Practice Address - Country:US
Practice Address - Phone:702-877-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0000BDBKSMedicare ID - Type Unspecified
NVC95849Medicare UPIN