Provider Demographics
NPI:1629398649
Name:ROBERT W PATTI MD CHTD
Entity Type:Organization
Organization Name:ROBERT W PATTI MD CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-734-8876
Mailing Address - Street 1:2080 E FLAMINGO RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5164
Mailing Address - Country:US
Mailing Address - Phone:702-734-8876
Mailing Address - Fax:702-734-9456
Practice Address - Street 1:2080 E FLAMINGO RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5164
Practice Address - Country:US
Practice Address - Phone:702-734-8876
Practice Address - Fax:702-734-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01119Medicare UPIN