=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932485869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ROBERT J FUTORAN PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2011
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 N BUFFALO DR STE D
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-410-5822
-----------------------------------------------------
Fax | 702-483-5507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9811 W CHARLESTON BLVD STE 2-691
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-7528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-410-5822
-----------------------------------------------------
Fax | 702-483-5507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT JAY FUTORAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-410-5822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 5253
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------