Provider Demographics
NPI:1386688182
Name:DE LAS ALAS, ROBERT MARQUEZ (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARQUEZ
Last Name:DE LAS ALAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 N GREEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8734
Practice Address - Country:US
Practice Address - Phone:317-852-2251
Practice Address - Fax:317-852-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200431620Medicaid
INP00887144OtherRAILROAD PTAN
IN200431620Medicaid
IN345630JMedicare PIN
INH93597Medicare UPIN