Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 9713 | NV |
NPI | 1114937158 |
---|---|
Provider Name | Dr. Mel C. Magboo |
First Address | Reno, NV 89502-6542 |
Second Address | Reno, NV 89502-6542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 01/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001516770 | (05) | NV |
H32851 | (02) | NV |