Provider Demographics
NPI:1528132057
Name:MCCANN, RAYMOND B (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:B
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:10300 W CHARLESTON BLVD
Mailing Address - Street 2:#13-191
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1037
Mailing Address - Country:US
Mailing Address - Phone:702-360-9500
Mailing Address - Fax:702-360-9547
Practice Address - Street 1:8685 W SAHARA AVE
Practice Address - Street 2:#180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5880
Practice Address - Country:US
Practice Address - Phone:702-360-9500
Practice Address - Fax:702-360-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV8640208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018030Medicaid
NV2018030Medicaid
NV30858Medicare PIN