MEDICARE: ROBERT S JEROME M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G87348	CA
2	208000000X	Pediatrics Physician	12828	NV

General Provider Information

NPI Number	:	1437291069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT S JEROME M.D.

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR STE 80
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0503
Country	:	US
Telephone Number	:	702-765-5437
Fax Number	:	702-240-7268

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 80
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0503
Country	:	US
Telephone Number	:	702-765-5437
Fax Number	:	702-240-7268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/15/2009

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Directions to “ ROBERT S JEROME M.D.” Practice Location

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