Basic Information
| Provider Information | |||||||||
| NPI: | 1992758726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 W OAKEY BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028735110 | ||||||||
| FaxNumber: | 7028738093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 006470 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 02002157 | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO2084 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200256280A | 05 | IN | MEDICAID | 1992758726 | 05 | NV | MEDICAID | 410042917 | 01 | IN | RAIL ROAD MEDICARE | OTHER | 675414 | 05 | AZ | MEDICAID | BL5764229 | 01 | IN | DEA NUMBER | OTHER | FL2601412 | 01 | AZ DEA | OTHER | 6740 | 01 | AZ | AZ LICENSE | OTHER | DO2084 | 01 | NV | STATE LICENSE | OTHER | 02002157 | 01 | IN | STATE LICENCE NUMBER | OTHER | 000000093781 | 01 | IN | ANTHEM NUMBER | OTHER |