Provider Demographics
NPI:1144205303
Name:NOUHAN, ROBERT VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:NOUHAN
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 1:1925 W MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3128
Mailing Address - Country:US
Mailing Address - Phone:303-833-8880
Mailing Address - Fax:303-682-8007
Practice Address - Street 1:1925 W MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3128
Practice Address - Country:US
Practice Address - Phone:303-833-8880
Practice Address - Fax:303-682-8007
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0038248207Q00000X
ORMD24239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11955562Medicaid
OR181942Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORP00081344OtherRR MEDICARE PTAN NUMBER
OR181942Medicaid
CO11955562Medicaid
ORH54377Medicare UPIN
OR0577260001Medicare NSC
CO345045YLB8Medicare PIN
CO809418Medicare PIN
OR930635514OtherGROUP TAX ID NUMBER
CO809418Medicare PIN