Healthcare Provider Details

I. General information

NPI: 1053372912
Provider Name (Legal Business Name): DAVID PATRICK MARMADUKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3059 S MARYLAND PKWY STE 100
LAS VEGAS NV
89109-6209
US

IV. Provider business mailing address

3059 S MARYLAND PKWY STE 100
LAS VEGAS NV
89109-6209
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-3441
  • Fax: 702-732-2310
Mailing address:
  • Phone: 702-732-3441
  • Fax: 702-732-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number10192
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberG86741
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number35066478
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10192
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35066478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: