=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063783280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNETTE F MAYES MD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2012
-----------------------------------------------------
Last Update Date | 02/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 SHADOW LANE SUITE #165
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-522-9640
-----------------------------------------------------
Fax | 702-522-9641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 SHADOW LANE SUITE #165
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-522-9640
-----------------------------------------------------
Fax | 702-522-9641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN, OWNER
-----------------------------------------------------
Name | ANNETTE F. MAYES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 702-522-9640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 7200
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------