Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 15518 | NV |
Y | 111NI0900X | Internist | 15518 | NV |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 15518 | NV |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | C34964 | CA |
NPI | 1770608580 |
---|---|
Provider Name | Dr. Robert Staton Chancellor |
First Address | Henderson, NV 89053-0815 |
Second Address | Las Vegas, NV 89148-7624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 27/10/2020 |