Provider Demographics
NPI:1841988136
Name:DYNAMIC MEDICAL GROUP LLC
Entity type:Organization
Organization Name:DYNAMIC MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERFE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-704-9611
Mailing Address - Street 1:3841 W CHARLESTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1858
Mailing Address - Country:US
Mailing Address - Phone:702-623-7990
Mailing Address - Fax:702-623-5033
Practice Address - Street 1:3841 W CHARLESTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1858
Practice Address - Country:US
Practice Address - Phone:702-623-7990
Practice Address - Fax:702-623-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty