MEDICARE: ROBERT HAROLD INGHAM MD

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	2084N0400X	Neurology Physician	8804	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8804	OTHER	NV	STATE BD OF MED EXAMINERS

General Provider Information

NPI Number	:	1851358410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HAROLD INGHAM MD

Provider Business Mailing Address
First Line	:	2940 S JONES BLVD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5630
Country	:	US
Telephone Number	:	702-227-6947
Fax Number	:	702-247-4319

Provider Business Practice Location Address
First Line	:	2940 S JONES BLVD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5630
Country	:	US
Telephone Number	:	702-227-6947
Fax Number	:	702-247-4319

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	01/11/2019

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