Healthcare Provider Details

I. General information

NPI: 1497189138
Provider Name (Legal Business Name): DOCTOR IS IN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8275 S EASTERN AVE STE 113
LAS VEGAS NV
89123-2591
US

IV. Provider business mailing address

450 N DOBSON RD STE 205
MESA AZ
85201-5278
US

V. Phone/Fax

Practice location:
  • Phone: 702-370-4309
  • Fax:
Mailing address:
  • Phone: 480-383-8599
  • Fax: 480-398-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN L MACDONALD
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 702-370-4309