Individual
DR. MERVYN BRUCE 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) 731-0741
Mailing address
PO BOX 50509, HENDERSON, NV 89016-0509
(702) 731-1616
(702) 731-0741
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
5401
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200006951
R.R. MEDICARE
—
05
—
2002961
—
NV
01
—
4294880
AETNA
—
01
—
NV8839
BXBS
—
Enumeration date
01/05/2006
Last updated
03/15/2012
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