Provider Demographics
NPI:1780785915
Name:DISKIN, S RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:S
Middle Name:RICHARD
Last Name:DISKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2598 WINDMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5476
Mailing Address - Country:US
Mailing Address - Phone:702-896-6043
Mailing Address - Fax:702-896-9591
Practice Address - Street 1:2598 WINDMILL PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5476
Practice Address - Country:US
Practice Address - Phone:702-896-6043
Practice Address - Fax:702-896-9591
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV386207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC02756Medicare UPIN