MEDICARE: MR. KIRK JACOB ROBINSON PA-C

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	363A00000X	Physician Assistant	PA1795	NV

General Provider Information

NPI Number	:	1710420641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIRK JACOB ROBINSON PA-C

Provider Business Mailing Address
First Line	:	1800 W. CHARLESTON BLVD. STE. 508
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-383-2688
Fax Number	:	702-671-6595

Provider Business Practice Location Address
First Line	:	4760 BLUE DIAMOND RD. STE. 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137
Country	:	US
Telephone Number	:	702-383-2300
Fax Number	:	702-678-1886

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

Provider Enumeration Date	:	11/26/2016
Last Update Date	:	10/15/2018

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