Healthcare Provider Details

I. General information

NPI: 1700048592
Provider Name (Legal Business Name): ROBERT A GATLIN MD CHTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY STE 3B
HENDERSON NV
89074-5885
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY STE 3B
HENDERSON NV
89074-5885
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-3200
  • Fax: 702-369-4727
Mailing address:
  • Phone: 702-737-3200
  • Fax: 702-369-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number3436
License Number StateNV

VIII. Authorized Official

Name: MR. ROBERT A GATLIN
Title or Position: CEO
Credential: MD
Phone: 702-737-3200