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General NPI Number Information
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NPI Number | 1730294455
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Entity Type | Individual
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Provider Name | MAXINE BONNIE INGHAM MD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 920 W OWENS AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89106-2516
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Country | US
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Telephone | 702-846-6622
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Fax | 702-685-9014
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Provider Business Mailing Address
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Address Line | 920 W OWENS AVE STE B
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City | LAS VEGAS
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State | NV
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Zip | 89106-2516
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Country | US
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Telephone | 702-864-6622
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Fax | 702-685-9014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8528
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | C42144
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 8528
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | M-10233
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 8528
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License Number State | NV
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Taxonomy #6
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | C42144
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 8528
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License Number State | NV
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8528
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License Number State | NV
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