Provider Demographics
NPI:1134110596
Name:GAO, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530369
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0369
Mailing Address - Country:US
Mailing Address - Phone:702-269-0781
Mailing Address - Fax:702-269-0788
Practice Address - Street 1:3022 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4440
Practice Address - Country:US
Practice Address - Phone:702-269-0781
Practice Address - Fax:702-269-0788
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9991208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9211OtherBCBS
NVV36621OtherMEDICARE ID
NVV36620OtherMEDICARE GROUP ID
NV002018489Medicaid
NVV36620OtherMEDICARE GROUP ID
NVH49692Medicare UPIN
NV1376576579Medicare PIN