Individual
MAXINE BONNIE INGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
920 W OWENS AVE STE B, LAS VEGAS, NV 89106-2516
(702) 846-6622
(702) 685-9014
Mailing address
920 W OWENS AVE STE B, LAS VEGAS, NV 89106-2516
(702) 864-6622
(702) 685-9014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8528
NV
207R00000X
Internal Medicine Physician
8528
NV
207RA0401X
Addiction Medicine (Internal Medicine) Physician
8528
NV
207RA0401X
Addiction Medicine (Internal Medicine) Physician
C42144
CA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
M-10233
ID
208M00000X
Hospitalist Physician
8528
NV
208M00000X
Hospitalist Physician
C42144
CA
261QP2300X
Primary Care Clinic/Center
8528
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002016755
—
NV
Enumeration date
08/21/2006
Last updated
06/25/2025
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