Provider Demographics
NPI:1063783280
Name:ANNETTE F MAYES MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANNETTE F MAYES MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-522-9640
Mailing Address - Street 1:700 SHADOW LANE
Mailing Address - Street 2:SUITE #165
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-522-9640
Mailing Address - Fax:702-522-9641
Practice Address - Street 1:700 SHADOW LANE
Practice Address - Street 2:SUITE #165
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-522-9640
Practice Address - Fax:702-522-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019271Medicaid
NVV111718Medicare PIN
NV35155Medicare PIN
NV002019271Medicaid