Provider Demographics
NPI:1114950805
Name:GAIMARO, ROBERT ANTHONY (PAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:GAIMARO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 S DECATUR BLVD
Mailing Address - Street 2:SUITE A-1A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6800
Mailing Address - Country:US
Mailing Address - Phone:702-798-7770
Mailing Address - Fax:702-895-7776
Practice Address - Street 1:4270 S DECATUR BLVD STE A-1A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6800
Practice Address - Country:US
Practice Address - Phone:702-798-7770
Practice Address - Fax:702-895-7776
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA978363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV54591OtherMEDICARE PTAN
NV1114950805Medicaid
NV100509546Medicaid
NVV105992Medicare PIN