Provider Demographics
NPI:1760544647
Name:DESMARAIS, GILLES MK (MD)
Entity Type:Individual
Prefix:MR
First Name:GILLES
Middle Name:MK
Last Name:DESMARAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97358
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-7358
Mailing Address - Country:US
Mailing Address - Phone:702-822-1188
Mailing Address - Fax:702-822-2020
Practice Address - Street 1:2915 W CHARLESTON
Practice Address - Street 2:#4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-822-1188
Practice Address - Fax:702-822-2020
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBD07129462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVMD5749Medicare ID - Type Unspecified
A73056Medicare UPIN