Provider Demographics
NPI:1861884314
Name:DR ROY MARGALLO MD
Entity type:Organization
Organization Name:DR ROY MARGALLO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-606-9009
Mailing Address - Street 1:10725 PRAIRIE WHEAT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8688
Mailing Address - Country:US
Mailing Address - Phone:702-900-1084
Mailing Address - Fax:702-991-7258
Practice Address - Street 1:10725 PRAIRIE WHEAT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-8688
Practice Address - Country:US
Practice Address - Phone:702-900-1084
Practice Address - Fax:702-991-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty