Individual
DR. DOLUE DAVID EZEANOLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 BEARDEN DR, SUITE 200, LAS VEGAS, NV 89106-4189
(702) 310-9110
(702) 310-9114
Mailing address
1701 BEARDEN DR, SUITE 200, LAS VEGAS, NV 89106-4189
(702) 310-9110
(702) 310-9114
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8421
NV
208100000X
Physical Medicine & Rehabilitation Physician
8421
NV
208VP0000X
Pain Medicine Physician
8421
NV
208VP0014X
Interventional Pain Medicine Physician
Primary
8421
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019939
—
NV
01
—
NV7125
BLUE CROSS BLUE SHIELD
NV
Enumeration date
06/30/2005
Last updated
09/12/2017
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