Provider Demographics
NPI:1255429841
Name:FIVECOAT, DENNIS JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAMES
Last Name:FIVECOAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2451 N RAINBOW BLVD
Mailing Address - Street 2:#1125
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4502
Mailing Address - Country:US
Mailing Address - Phone:702-645-4469
Mailing Address - Fax:702-643-4282
Practice Address - Street 1:4511 W CHEYENNE AVE
Practice Address - Street 2:STE 700
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2450
Practice Address - Country:US
Practice Address - Phone:702-643-4279
Practice Address - Fax:702-643-4282
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1038237OtherNCCPA