Healthcare Provider Details

I. General information

NPI: 1871917260
Provider Name (Legal Business Name): HUGO ROBERT PAULSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 N. TENAYA WAY STE. 208
LAS VEGAS NV
89128-1104
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-7451
  • Fax: 909-557-1924
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number630
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: