Healthcare Provider Details

I. General information

NPI: 1831129014
Provider Name (Legal Business Name): HINSHAW DERMATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR SUITE #400
LAS VEGAS NV
89144-0514
US

IV. Provider business mailing address

5130 S FORT APACHE RD #215-379
LAS VEGAS NV
89148-1719
US

V. Phone/Fax

Practice location:
  • Phone: 702-343-3522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11644
License Number StateNV

VIII. Authorized Official

Name: DR. CLAYTON THOMAS HINSHAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-890-5883