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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XL2341TXN Allopathic & Osteopathic PhysiciansFamily Medicine 
207QS0010XL2341TXN Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
207Q00000X15834NVY Allopathic & Osteopathic PhysiciansFamily Medicine 
207QS0010X15834NVN Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine

ID Information
IDTypeStateIssuerDescription
14412630105TX MEDICAID
8G968001TXBCBS OF TEXASOTHER


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