Provider Demographics
NPI: | 1508979295 |
---|---|
Name: | COON, DAVID (MD, PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DAVID |
Middle Name: | |
Last Name: | COON |
Suffix: | |
Gender: | M |
Credentials: | MD, PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7455 W WASHINGTON AVE |
Mailing Address - Street 2: | SUITE 301 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89128-4337 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 877-562-5227 |
Mailing Address - Fax: | 702-938-9954 |
Practice Address - Street 1: | 7455 W WASHINGTON AVE |
Practice Address - Street 2: | SUITE 301 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89128-4337 |
Practice Address - Country: | US |
Practice Address - Phone: | 877-562-5227 |
Practice Address - Fax: | 702-938-9954 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-16 |
Last Update Date: | 2017-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A88126 | 207ZP0102X |
HI | 13358 | 207ZP0102X |
NV | 13113 | 207ZP0102X |
AZ | 37873 | 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | Z129454 | Medicare PIN | |
NV | BY354Y | Medicare PIN | |
HI | I35952 | Medicare UPIN |