Healthcare Provider Details

I. General information

NPI: 1134110596
Provider Name (Legal Business Name): ROBERT R GAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 S DURANGO DR STE 100
LAS VEGAS NV
89117-4440
US

IV. Provider business mailing address

PO BOX 530369
HENDERSON NV
89053-0369
US

V. Phone/Fax

Practice location:
  • Phone: 702-269-0781
  • Fax: 702-269-0788
Mailing address:
  • Phone: 702-269-0781
  • Fax: 702-269-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number9991
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: