Provider Demographics
NPI:1053320564
Name:TAIT, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:TAIT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10561 JEFFREYS ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4266
Mailing Address - Country:US
Mailing Address - Phone:702-565-6565
Mailing Address - Fax:702-565-8898
Practice Address - Street 1:10561 JEFFREYS ST
Practice Address - Street 2:SUITE 230
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4266
Practice Address - Country:US
Practice Address - Phone:702-565-6565
Practice Address - Fax:702-565-8898
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV7367207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200032264OtherRAILROAD MEDICARE
NV002019672Medicaid
NV0655010001Medicare NSC
NV002019672Medicaid
NVWQBDS02Medicare ID - Type Unspecified