Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 266725 | MA |
N | 208600000X | Surgeon | 266725 | MA |
N | 208200000X | Surgeon | A122852 | CA |
N | 208600000X | Surgeon | A122852 | CA |
N | 2086S0105X | Surgery of the Hand | S5596 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | S5596 | TX |
NPI | 1043509813 |
---|---|
Provider Name | Shawn Diamond |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 08/07/2020 |