Provider Demographics
NPI:1376592386
Name:ROBERTS, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ROBERTS
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 1:6301 MOUNTAIN VISTA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-614-5437
Mailing Address - Fax:702-990-9922
Practice Address - Street 1:6301 MOUNTAIN VISTA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2364
Practice Address - Country:US
Practice Address - Phone:702-614-5437
Practice Address - Fax:702-990-9922
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist