Provider Demographics
NPI:1891773404
Name:MENEZES, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MENEZES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3016 W CHARLESTON BLVD
Mailing Address - Street 2:STE 100, CREDENTIALING DEPARTMENT
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-2311
Mailing Address - Fax:702-671-6430
Practice Address - Street 1:1707 W CHARLESTON BLVD
Practice Address - Street 2:#190, PLASTIC SURGERY CLINIC
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2351
Practice Address - Country:US
Practice Address - Phone:702-671-5110
Practice Address - Fax:702-684-6592
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV102002082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS11260OtherPHARMACY/CDS
NV002018698Medicaid
NVBM5170422OtherDEA
NVH62544Medicare UPIN
NVWQBHV36507Medicare ID - Type Unspecified