Basic Information
Provider Information | |||||||||
NPI: | 1003888751 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAKS | ||||||||
FirstName: | ROBIN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MURPHY | ||||||||
OtherFirstName: | ROBIN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3200 E CAMELBACK RD | ||||||||
Address2: | STE 250 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850182327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4802142300 | ||||||||
FaxNumber: | 4802142301 | ||||||||
Practice Location | |||||||||
Address1: | 2550 E GUADALUPE RD | ||||||||
Address2: | #115 | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 852345114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4802142300 | ||||||||
FaxNumber: | 4802142301 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2006 | ||||||||
LastUpdateDate: | 08/03/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/03/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25760 | AZ | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 00014246 | 01 | AZ | BANNER HEALTH PLAN | OTHER | 025760 | 01 | AZ | MAYO INSURANCE | OTHER | 473306 | 05 | AZ |   | MEDICAID | 860224023 | 01 | AZ | UNITED HEALTHCARE | OTHER | 1Z6554 | 01 | AZ | HEALTHNET | OTHER | 4733060 | 01 | AZ | DEPT OF ECONOMIC SECURITY | OTHER | 473306 | 01 | AZ | APIPA INSURANCE | OTHER | AZ0866160 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER |