Provider Demographics
NPI:1942410865
Name:MCGAURAN, MATTHEW D (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:MCGAURAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 530010
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0010
Mailing Address - Country:US
Mailing Address - Phone:702-361-2273
Mailing Address - Fax:702-361-6885
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7949
Practice Address - Country:US
Practice Address - Phone:702-361-2273
Practice Address - Fax:702-361-6885
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBW145ZMedicare PIN