# DIAMOND MEDICAL SPA AND VEIN, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366706319
- **Authorized official:** LEROY L. YATES MD (OWNER)
- **Authorized official phone:** (563) 505-5372

## Contact information

- **Practice address:** 3170 E 53RD ST, DAVENPORT, IA 52807-3864
- **Practice address phone:** (563) 505-5372
- **Mailing address:** 3170 E 53RD ST, DAVENPORT, IA 52807-3864
- **Mailing address phone:** (563) 505-5372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 036-076186 | IL | — |
| 207V00000X | Obstetrics & Gynecology Physician | 27540 | IA | Yes |

## Other

- **Enumeration date:** 06/25/2012
- **Last updated:** 06/25/2012