Individual
DR. MATTHEW NOLAN FOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 E DESERT INN RD, SUITE #100, LAS VEGAS, NV 89121-3608
(702) 731-1616
(702) 734-4900
Mailing address
PO BOX 50509, HENDERSON, NV 89016-0509
(702) 731-1616
(702) 734-4900
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
12206
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100512161
—
NV
01
—
103890
MEDICARE PTAN
—
01
—
7417894
AETNA
—
01
—
NV4937
BC/BS
—
Enumeration date
05/17/2006
Last updated
10/09/2018
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