Provider Demographics
NPI:1457441206
Name:GOLAN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:GOLAN
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 1:3753 HOWARD HUGHES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-0952
Mailing Address - Country:US
Mailing Address - Phone:702-419-5379
Mailing Address - Fax:702-546-5654
Practice Address - Street 1:3753 HOWARD HUGHES PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0952
Practice Address - Country:US
Practice Address - Phone:702-419-5379
Practice Address - Fax:702-546-5654
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7091208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation