Provider Demographics
NPI:1720324429
Name:ELMER S. DAVID, MD, PLLC
Entity Type:Organization
Organization Name:ELMER S. DAVID, MD, PLLC
Other - Org Name:A LAS VEGAS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAXECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-733-0744
Mailing Address - Street 1:5876 S. PECOS RD. BLDG. B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-733-0744
Mailing Address - Fax:702-796-8262
Practice Address - Street 1:5876 S. PECOS RD. BLDG. B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-733-0744
Practice Address - Fax:702-796-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1091207Q00000X
NV14165208000000X
NJ25MA058001002080N0001X
NVAPRN001848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5234409Medicaid
NJF38397Medicare UPIN
NJ109671Medicare PIN