Healthcare Provider Details

I. General information

NPI: 1083935811
Provider Name (Legal Business Name): ROBERT WILLIAM BALSIGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 WELLNESS WAY STE 300
LAS VEGAS NV
89106-4145
US

IV. Provider business mailing address

1930 VILLAGE CENTER CIR STE 306
LAS VEGAS NV
89134-6299
US

V. Phone/Fax

Practice location:
  • Phone: 702-432-2233
  • Fax:
Mailing address:
  • Phone: 702-432-2233
  • Fax: 702-800-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO1855
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberSL0742
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: