Healthcare Provider Details

I. General information

NPI: 1528132057
Provider Name (Legal Business Name): RAYMOND B MCCANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8685 W SAHARA AVE #180
LAS VEGAS NV
89117-5880
US

IV. Provider business mailing address

10300 W CHARLESTON BLVD #13-191
LAS VEGAS NV
89135-1037
US

V. Phone/Fax

Practice location:
  • Phone: 702-360-9500
  • Fax: 702-360-9547
Mailing address:
  • Phone: 702-360-9500
  • Fax: 702-360-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number8640
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: