Basic Information
| Provider Information | |||||||||
| NPI: | 1992773907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBISON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | RULON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29504 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028780070 | ||||||||
| FaxNumber: | 7028702520 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 W CHARLESTON BLVD | ||||||||
| Address2: | STE 150 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028780070 | ||||||||
| FaxNumber: | 7028782520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 7755 | NV | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2019738 | 05 | NV | MEDICAID |