Provider Demographics
NPI:1376502880
Name:NOVERO, JIMMY JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY JOHN
Middle Name:N
Last Name:NOVERO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:SUITE 555
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-685-8392
Mailing Address - Fax:702-475-5219
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 555
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-685-8392
Practice Address - Fax:702-475-5219
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV128482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376502880Medicaid
NV1376502880Medicaid