Healthcare Provider Details

I. General information

NPI: 1053551374
Provider Name (Legal Business Name): BENJAMIN J MCGARVEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 12/16/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 W. SKYE CAYON PARK DR STE #170
LAS VEGAS NV
89166
US

IV. Provider business mailing address

9800 W SKYE CANYON PARK DR STE 170
LAS VEGAS NV
89166-6631
US

V. Phone/Fax

Practice location:
  • Phone: 702-425-5119
  • Fax: 702-213-6079
Mailing address:
  • Phone: 702-425-5119
  • Fax: 702-213-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1636
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: