Provider Demographics
NPI:1538314950
Name:MARGALLO, ROY MARIE A (MD)
Entity Type:Individual
Prefix:
First Name:ROY MARIE
Middle Name:A
Last Name:MARGALLO
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 1:10624 S EASTERN AVE STE A-955
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-380-1888
Mailing Address - Fax:702-463-1507
Practice Address - Street 1:10624 S EASTERN AVE STE A-955
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2982
Practice Address - Country:US
Practice Address - Phone:702-380-1888
Practice Address - Fax:702-463-1507
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine