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NPI Code Detail

MEDICARE: RUSSELL JAYNE MD LTD

MEDICARE: RUSSELL JAYNE MD LTD
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
1207W00000XOphthalmology Physician9106NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA5010OTHERNVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669479663
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL JAYNE MD LTD
Provider Business Mailing Address
First Line : PO BOX 50708
Second Line :
City : HENDERSON
State : NV
Zip : 89016-0708
Country : US
Telephone Number : 702-737-7258
Fax Number : 702-454-7258
Provider Business Practice Location Address
First Line : 6839 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-1635
Country : US
Telephone Number : 702-737-7258
Fax Number : 702-454-7258
Authorized Official
Title or Position : PRESIDENT
Name : DR. RUSSELL PATRICK JAYNE
Credential : MD
Telephone Number : 702-737-7258
Provider Enumeration Date : 07/05/2005
Last Update Date : 09/27/2018

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Directions to “RUSSELL JAYNE MD LTD ” Practice Location

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