Provider Demographics
NPI:1144302175
Name:MCDERMOTT & BROGAN, LTD
Entity type:Organization
Organization Name:MCDERMOTT & BROGAN, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-324-4500
Mailing Address - Street 1:2345 E PRATER WAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9600
Mailing Address - Country:US
Mailing Address - Phone:775-324-4500
Mailing Address - Fax:775-327-4121
Practice Address - Street 1:2345 E PRATER WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9600
Practice Address - Country:US
Practice Address - Phone:775-324-4500
Practice Address - Fax:775-327-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33690Medicare ID - Type Unspecified