Provider Demographics
NPI:1629058805
Name:DEEM, KANE MATTHEW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KANE
Middle Name:MATTHEW
Last Name:DEEM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1460 SOUTH CURRY STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-883-3336
Mailing Address - Fax:775-883-0877
Practice Address - Street 1:1511 GRANT AVE
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7824
Practice Address - Country:US
Practice Address - Phone:775-445-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36326Medicaid