Provider Demographics
NPI:1215901376
Name:FARRIMOND, DERALD (MD)
Entity type:Individual
Prefix:
First Name:DERALD
Middle Name:
Last Name:FARRIMOND
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 1:8936 SPANISH RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1354
Mailing Address - Country:US
Mailing Address - Phone:702-998-2816
Mailing Address - Fax:702-998-2991
Practice Address - Street 1:7324 W CHEYENNE AVE STE 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7426
Practice Address - Country:US
Practice Address - Phone:702-575-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV119972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215901376Medicaid