Provider Demographics
NPI:1013928886
Name:GERMIN, LEO R (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:R
Last Name:GERMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 530786
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0786
Mailing Address - Country:US
Mailing Address - Phone:702-804-1574
Mailing Address - Fax:702-804-1222
Practice Address - Street 1:1691 WEST HORIZON RIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-804-1212
Practice Address - Fax:702-804-1273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV78662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019758Medicaid
NVV37483Medicare PIN
NVF80599Medicare UPIN