Provider Demographics
NPI:1922395649
Name:GOBER MCDANIEL, JENNY KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:KATHLEEN
Last Name:GOBER MCDANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 W WARM SPRINGS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3629
Mailing Address - Country:US
Mailing Address - Phone:702-330-0555
Mailing Address - Fax:702-832-1128
Practice Address - Street 1:8352 W WARM SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3629
Practice Address - Country:US
Practice Address - Phone:702-330-0555
Practice Address - Fax:702-832-1128
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33830208000000X
NC2017-01884208000000X, 2080P0207X
NV268722080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250036193Medicaid