Provider Demographics
NPI:1750380747
Name:MCBRIDE, STEPHEN DANIEL (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DANIEL
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:DANIEL
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:SUITE #370
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4126
Mailing Address - Country:US
Mailing Address - Phone:702-382-8222
Mailing Address - Fax:702-385-3073
Practice Address - Street 1:700 SHADOW LN
Practice Address - Street 2:SUITE #370
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4126
Practice Address - Country:US
Practice Address - Phone:702-382-8222
Practice Address - Fax:702-385-3073
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002491Medicaid
020012711Medicare PIN
C96323Medicare UPIN
NVV02WCHFL03Medicare PIN