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NPI Code Detail

MEDICARE: DESERT DERMATOLOGY LLC

MEDICARE: DESERT DERMATOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist11221NV

General Provider Information

NPI Number : 1255599577
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT DERMATOLOGY LLC
Provider Business Mailing Address
First Line : 9167 W FLAMINGO RD
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number : 702-233-4569
Fax Number : 702-255-3223
Provider Business Practice Location Address
First Line : 9167 W FLAMINGO RD
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89147-6472
Country : US
Telephone Number : 702-233-4569
Fax Number : 702-255-3223
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT IVAN LEPOSAVIC
Credential : M.D.
Telephone Number : 702-233-4569
Provider Enumeration Date : 05/23/2008
Last Update Date : 11/01/2013

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Directions to “DESERT DERMATOLOGY LLC ” Practice Location

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