Provider Demographics
NPI:1558618710
Name:MARVIN D SPANN MD PLLC
Entity Type:Organization
Organization Name:MARVIN D SPANN MD PLLC
Other - Org Name:COUTURE DERMATOLOGY AND PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-998-9001
Mailing Address - Street 1:PO BOX 35914
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5914
Mailing Address - Country:US
Mailing Address - Phone:702-998-9001
Mailing Address - Fax:702-998-8282
Practice Address - Street 1:9950 W FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8555
Practice Address - Country:US
Practice Address - Phone:702-998-9001
Practice Address - Fax:702-998-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13132207N00000X
NV13247208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134548456OtherNPI
NV1407044399OtherNPI
NV1972750370OtherNPI
NV1043716251OtherNPI
NV1700964780OtherNPI
NV1972263622OtherNPI
NV1871964676OtherNPI