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NPI Code Detail

MEDICARE: DR. JERRY MAKIN D.O.

MEDICARE: DR. JERRY MAKIN D.O.
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
12084P0800XPsychiatry Physician20A13945CA

General Provider Information

NPI Number : 1649291675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY MAKIN D.O.
Provider Business Mailing Address
First Line : 916 W OWENS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2516
Country : US
Telephone Number : 702-768-7300
Fax Number :
Provider Business Practice Location Address
First Line : 916 W OWENS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2516
Country : US
Telephone Number : 702-768-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 05/19/2015

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Directions to “ DR. JERRY MAKIN D.O.” Practice Location

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