Provider Demographics
NPI:1922007244
Name:MCNULTY, PATRICK S (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3012 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9186
Mailing Address - Country:US
Mailing Address - Phone:702-835-0088
Mailing Address - Fax:702-826-3162
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3508
Practice Address - Country:US
Practice Address - Phone:702-463-1424
Practice Address - Fax:702-901-4112
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8238207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1922007244Medicaid
NV20-19895Medicaid
V20WCHTN-21Medicare PIN