Individual
DR. GARY MAX DESHAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2901 N TENAYA WAY STE 100, LAS VEGAS, NV 89128-1404
(702) 870-8852
(702) 870-8914
Mailing address
2901 N TENAYA WAY STE 100, LAS VEGAS, NV 89128-1404
(702) 870-8852
(702) 870-8914
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
380
NV
2083P0901X
Public Health & General Preventive Medicine Physician
380
NV
261QC1500X
Community Health Clinic/Center
380
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002002672
—
NV
01
—
CC4619
BLUE CROSS PIN
NV
Enumeration date
01/12/2007
Last updated
02/17/2022
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