Provider Demographics
NPI:1801857586
Name:PRINCE, KEVIN DARRELL (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DARRELL
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7465 UTE MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5938
Mailing Address - Country:US
Mailing Address - Phone:702-658-3232
Mailing Address - Fax:
Practice Address - Street 1:2231 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2254
Practice Address - Country:US
Practice Address - Phone:702-383-6276
Practice Address - Fax:702-671-6198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV6284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F56541Medicare UPIN