MEDICARE: DR. JOSHUA MACON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	9866	NV
2	207L00000X	Anesthesiology Physician	G2184	TX

General Provider Information

NPI Number	:	1053313742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA MACON M.D.

Provider Business Mailing Address
First Line	:	9260 W SUNSET RD
Second Line	:	STE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4903
Country	:	US
Telephone Number	:	702-562-3039
Fax Number	:	702-562-6928

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR
Second Line	:	SUITE 402
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0514
Country	:	US
Telephone Number	:	702-562-3039
Fax Number	:	702-562-6928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	04/23/2018

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Directions to “ DR. JOSHUA MACON M.D.” Practice Location

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