Provider Demographics
NPI:1114949492
Name:DAULAT, JALDEEP H (DO)
Entity Type:Individual
Prefix:DR
First Name:JALDEEP
Middle Name:H
Last Name:DAULAT
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 1:9750 W SKYE CANYON PARK DR
Mailing Address - Street 2:SUITE 160 BOX 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166
Mailing Address - Country:US
Mailing Address - Phone:702-683-1727
Mailing Address - Fax:702-974-0440
Practice Address - Street 1:3975 S DURANGO DR STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4156
Practice Address - Country:US
Practice Address - Phone:702-628-5333
Practice Address - Fax:702-974-0440
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV363207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV070003254OtherRAILROAD MEDICARE
NV1114949492Medicaid
AZ070012029OtherRAILROAD MEDICARE
AZ070012029OtherRAILROAD MEDICARE
NVV35507Medicare PIN
NV7WCCDP0Medicare PIN