Provider Demographics
NPI:1841292315
Name:ROBEN, THOMAS SAMUEL (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SAMUEL
Last Name:ROBEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:#150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7150
Practice Address - Country:US
Practice Address - Phone:702-228-5477
Practice Address - Fax:702-671-6883
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV862OtherSTATE LICENSE
NV1841292315Medicaid
NVP00853280OtherRAILROAD MEDICARE