Provider Demographics
NPI:1942208426
Name:PROTHRO, DAVID LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEROY
Last Name:PROTHRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:816 22ND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2206
Mailing Address - Country:US
Mailing Address - Phone:308-865-2263
Mailing Address - Fax:308-865-2541
Practice Address - Street 1:2385 E PRATER WAY
Practice Address - Street 2:STE 309
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9629
Practice Address - Country:US
Practice Address - Phone:775-322-4449
Practice Address - Fax:775-322-0723
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-10-04
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Provider Licenses
StateLicense IDTaxonomies
NE31985207RC0001X
NV7123207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016534Medicaid
NVV104510Medicare PIN
NV002016534Medicaid