Provider Demographics
NPI:1295784585
Name:DIAMOND, ALAN SLOAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:SLOAN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 S. RAINBOW BLVD #101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-214-9729
Mailing Address - Fax:702-942-1136
Practice Address - Street 1:5495 S. RAINBOW BLVD #101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-214-9729
Practice Address - Fax:702-942-1136
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2011532085R0202X
CAC522792085R0202X
NV128492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22940301Medicaid
P00472631OtherRAILROAD MEDICARE
OH2705255Medicaid
ID807571900Medicaid
NY01740532Medicaid
NY01740532Medicaid
OH2705255Medicaid