NPI 1174086391 · live from the CMS NPI Registry
Grant A Bullock
Psychiatry & Neurology, Psychiatry in Las Vegas, NV. National Provider Identifier 1174086391, active.
NPI record
| NPI | 1174086391 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychiatry & Neurology, Psychiatry 2084P0800X |
| Practice location | 4029 Dean Martin Dr, Las Vegas, NV 89103 |
| Practice phone | 702-848-2256 |
| Mailing address | 3014 W Charleston Blvd Ste 130, Las Vegas, NV 89102 |
| Enumerated | April 14, 2019 |
| Last updated | February 26, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatry & Neurology, Psychiatry primary | 2084P0800X | DO3385 (NV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.