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NPI Code Detail

MEDICARE: DR. TERRY JOSEPH MCANALLEN D.O.

MEDICARE: DR. TERRY JOSEPH MCANALLEN 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
1207Q00000XFamily Medicine Physician1484NV
2207Q00000XFamily Medicine PhysicianDO1484NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DO1484OTHERNVSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871504969
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY JOSEPH MCANALLEN D.O.
Provider Business Mailing Address
First Line : 6355 S BUFFALO DR FL 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2133
Country : US
Telephone Number : 702-216-3346
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 595 W LAKE MEAD PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89015-7015
Country : US
Telephone Number : 702-566-5500
Fax Number : 702-558-7238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 10/19/2022

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