Provider Demographics
NPI:1114937158
Name:MAGBOO, MEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:C
Last Name:MAGBOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NEIL RD
Mailing Address - Street 2:#207
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6542
Mailing Address - Country:US
Mailing Address - Phone:775-398-1981
Mailing Address - Fax:775-398-1984
Practice Address - Street 1:5250 NEIL RD
Practice Address - Street 2:#207
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6542
Practice Address - Country:US
Practice Address - Phone:775-398-1981
Practice Address - Fax:775-398-1984
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9713207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001516770Medicaid
NVH32851Medicare UPIN
NV001516770Medicaid