Individual
MARY JANE MAGRUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2020 PALOMINO LN, SUITE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1815
Mailing address
2020 PALOMINO LN, STE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1815
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
8314
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649212564
—
CA
05
—
200290024
—
NV
05
—
200471160A
—
OK
01
—
P01168764
RR MEDICARE
NV
Enumeration date
06/12/2006
Last updated
11/19/2014
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