1003888751 NPI number — ROBIN LAKS M.D.

Table of content: ROBIN LAKS M.D. (NPI 1003888751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003888751 NPI number — ROBIN LAKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKS
Provider First Name:
ROBIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
ROBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003888751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 E CAMELBACK RD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-2327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-214-2300
Provider Business Mailing Address Fax Number:
480-214-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 E GUADALUPE RD
Provider Second Line Business Practice Location Address:
#115
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-214-2300
Provider Business Practice Location Address Fax Number:
480-214-2301
Provider Enumeration Date:
02/06/2006

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: 208000000X , with the licence number:  25760 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00014246 . This is a "BANNER HEALTH PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 025760 . This is a "MAYO INSURANCE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 473306 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 860224023 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z6554 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4733060 . This is a "DEPT OF ECONOMIC SECURITY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 473306 . This is a "APIPA INSURANCE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0866160 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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