Provider Demographics
NPI:1053589838
Name:KAREN DALLEY MD LTD
Entity type:Organization
Organization Name:KAREN DALLEY MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-869-0070
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 514
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-869-0070
Mailing Address - Fax:702-869-0071
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 514
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-869-0070
Practice Address - Fax:702-869-0071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN DALLEY MD LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0299896OtherGHI
NV160027394OtherRAILROAD MEDICARE
NV2019327Medicaid
NVNV7399OtherBCBS OF NEVADA
NV2019327Medicaid
NVF66271Medicare UPIN