MEDICARE: RICHARD MAW MD PC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1770668337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD MAW MD PC

Provider Business Mailing Address
First Line	:	2505 ANTHEM VILLAGE DR # E-594
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5505
Country	:	US
Telephone Number	:	702-642-7711
Fax Number	:	702-642-8822

Provider Business Practice Location Address
First Line	:	2517 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6410
Country	:	US
Telephone Number	:	702-642-7711
Fax Number	:	702-642-8822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD J MAW
Credential	:	M.D.
Telephone Number	:	702-642-7711

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/29/2009

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