MEDICARE: DR. GAREY LEE MCLELLAN 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	2085R0202X	Diagnostic Radiology Physician	F1809	TX
2	2085R0202X	Diagnostic Radiology Physician	6373	NV
3	2085R0202X	Diagnostic Radiology Physician	ME45603	FL
4	2085R0202X	Diagnostic Radiology Physician	26006	AZ
5	2085R0202X	Diagnostic Radiology Physician	01075082A	IN
6	2085R0204X	Vascular & Interventional Radiology Physician	01075082A	IN

General Provider Information

NPI Number	:	1881665826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAREY LEE MCLELLAN M.D.

Provider Business Mailing Address
First Line	:	10615 PATRINGTON CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4562
Country	:	US
Telephone Number	:	702-577-7362
Fax Number	:	702-897-9013

Provider Business Practice Location Address
First Line	:	10615 PATRINGTON CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4562
Country	:	US
Telephone Number	:	702-577-7362
Fax Number	:	702-897-9013

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	10/07/2015

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