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General NPI Number Information
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NPI Number | 1063410918
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGING OF SOUTHERN NEVADA
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 3560 E FLAMINGO RD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89121-5044
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Country | US
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Telephone | 702-433-6100
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Fax | 702-433-9576
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Provider Business Mailing Address
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Address Line | 3560 E FLAMINGO RD SUITE 100
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City | LAS VEGAS
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State | NV
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Zip | 89121-5044
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Country | US
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Telephone | 702-433-6100
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Fax | 702-433-9576
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Authorized Official
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Title or Position | MANAGER OF GENERAL PARTNER
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Name | DR. MICHAEL ALLEN BARON
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Credential | M.D.
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Telephone | 702-433-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2000048426
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License Number State | NV
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