Basic Information
Provider Information | |||||||||
NPI: | 1265490205 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ISLAS | ||||||||
FirstName: | ARTHUR | ||||||||
MiddleName: | ANTHONY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 401 W. 2ND ST. | ||||||||
Address2: | #235D / NELSON BLDG / MS 353 | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 89503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7756828175 | ||||||||
FaxNumber: | 7753272006 | ||||||||
Practice Location | |||||||||
Address1: | 123 17TH ST. | ||||||||
Address2: | MS 316 | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 89557 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7757841533 | ||||||||
FaxNumber: | 7757848075 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2006 | ||||||||
LastUpdateDate: | 07/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L2341 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207QS0010X | L2341 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 15834 | NV | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207QS0010X | 15834 | NV | N |   | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 144126301 | 05 | TX |   | MEDICAID | 8G9680 | 01 | TX | BCBS OF TEXAS | OTHER |