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
StateLicense IDTaxonomies
CAA88126207ZP0102X
HI13358207ZP0102X
NV13113207ZP0102X
AZ37873207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129454Medicare PIN
NVBY354YMedicare PIN
HII35952Medicare UPIN