Healthcare Provider Details

I. General information

NPI: 1063410918
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING OF SOUTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 E FLAMINGO RD SUITE 100
LAS VEGAS NV
89121-5044
US

IV. Provider business mailing address

3560 E FLAMINGO RD SUITE 100
LAS VEGAS NV
89121-5044
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-6100
  • Fax: 702-433-9576
Mailing address:
  • Phone: 702-433-6100
  • Fax: 702-433-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2000048426
License Number StateNV

VIII. Authorized Official

Name: DR. MICHAEL ALLEN BARON
Title or Position: MANAGER OF GENERAL PARTNER
Credential: M.D.
Phone: 702-433-6100