Basic Information
| Provider Information | |||||||||
| NPI: | 1053372912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARMADUKE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3059 S MARYLAND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891096209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027323441 | ||||||||
| FaxNumber: | 7027322310 | ||||||||
| Practice Location | |||||||||
| Address1: | 3059 S MARYLAND PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891096209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027323441 | ||||||||
| FaxNumber: | 7027322310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZH0000X | 10192 | NV | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZH0000X | G86741 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZH0000X | 35066478 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | 10192 | NV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 35066478 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 200225022 | 05 | NV | MEDICAID |