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NPI Code Detail

MEDICARE: DR. MARVIN DOUGLAS SPANN M.D.

MEDICARE: DR. MARVIN DOUGLAS SPANN 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
1208200000XPlastic Surgery Physician6664375-1205UT
2208200000XPlastic Surgery Physician13247NV

General Provider Information

NPI Number : 1407044399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN DOUGLAS SPANN M.D.
Provider Business Mailing Address
First Line : PO BOX 35914
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5914
Country : US
Telephone Number : 702-998-8486
Fax Number : 702-998-8282
Provider Business Practice Location Address
First Line : 2615 BOX CANYON DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0450
Country : US
Telephone Number : 702-998-8486
Fax Number : 702-998-8282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2007
Last Update Date : 08/09/2012

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