Healthcare Provider Details

I. General information

NPI: 1265212906
Provider Name (Legal Business Name): ROBERT WILLIAM ALTRICH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

IV. Provider business mailing address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-2400
  • Fax:
Mailing address:
  • Phone: 702-566-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3053
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008285
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberPA.0008285
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: