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NPI Code Detail

MEDICARE: JODY RANDELL CEARLOCK

MEDICARE: JODY RANDELL CEARLOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician8471NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245230713
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY RANDELL CEARLOCK
Provider Business Mailing Address
First Line : PO BOX 36900
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-6900
Country : US
Telephone Number : 702-732-6000
Fax Number : 702-243-7531
Provider Business Practice Location Address
First Line : 2950 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2204
Country : US
Telephone Number : 702-732-6000
Fax Number : 702-243-7531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 12/03/2010

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Directions to “ JODY RANDELL CEARLOCK ” Practice Location

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