Healthcare Provider Details

I. General information

NPI: 1912117359
Provider Name (Legal Business Name): ROBIN WILLCOURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S HUMBOLDT ST
BATTLE MOUNTAIN NV
89820-1988
US

IV. Provider business mailing address

535 S HUMBOLDT ST
BATTLE MOUNTAIN NV
89820-1988
US

V. Phone/Fax

Practice location:
  • Phone: 775-635-2424
  • Fax: 775-635-2437
Mailing address:
  • Phone: 775-635-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6350
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number6350
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: