Provider Demographics
NPI:1972597367
Name:LOKSHIN, BORIS (MD)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:LOKSHIN
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 1:2135 GREEN VISTA DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8544
Mailing Address - Country:US
Mailing Address - Phone:775-359-5010
Mailing Address - Fax:775-359-5076
Practice Address - Street 1:2135 GREEN VISTA DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8544
Practice Address - Country:US
Practice Address - Phone:775-359-5010
Practice Address - Fax:775-359-5076
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7585207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0016805Medicaid
NE03WCGVM03Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NV0016805Medicaid