Individual
RUSSELL P JAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6839 W CHARLESTON BLVD, LAS VEGAS, NV 89117-1635
(702) 737-7258
(702) 454-7258
Mailing address
PO BOX 50708, HENDERSON, NV 89016-0708
(702) 737-7258
(702) 454-7258
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
9106
NV
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
9106
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018156
—
NV
01
—
P00061198
RAILROAD MEDICARE
NV
Enumeration date
07/05/2005
Last updated
02/16/2023
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