Provider Demographics
NPI:1851358410
Name:INGHAM, ROBERT HAROLD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HAROLD
Last Name:INGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2940 S JONES BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5630
Mailing Address - Country:US
Mailing Address - Phone:702-227-6947
Mailing Address - Fax:702-247-4319
Practice Address - Street 1:2940 S JONES BLVD STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5630
Practice Address - Country:US
Practice Address - Phone:702-227-6947
Practice Address - Fax:702-247-4319
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV88042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8804OtherSTATE BD OF MED EXAMINERS
NV8804OtherSTATE BD OF MED EXAMINERS