1699841254 NPI number — ROBERT C O'LAUGHLIN M.D.

Table of content: ROBERT C O'LAUGHLIN M.D. (NPI 1699841254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699841254 NPI number — ROBERT C O'LAUGHLIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'LAUGHLIN
Provider First Name:
ROBERT
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699841254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3006 S MARYLAND PKWY
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89109-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-735-7154
Provider Business Mailing Address Fax Number:
702-735-7153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8285 W ARBY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-735-7154
Provider Business Practice Location Address Fax Number:
702-405-1862
Provider Enumeration Date:
11/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD10713 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 45674 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 12398 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)