Provider Demographics
NPI:1528048931
Name:HOSTETTER, ROBERT CLYDE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLYDE
Last Name:HOSTETTER
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 1:3916 STATE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3137
Mailing Address - Country:US
Mailing Address - Phone:831-385-4603
Mailing Address - Fax:831-385-0414
Practice Address - Street 1:300 CANAL ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3431
Practice Address - Country:US
Practice Address - Phone:831-385-6000
Practice Address - Fax:831-385-0414
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33650207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G336500Medicaid
CA00G336500Medicare PIN
CAA45623Medicare UPIN
CA00G336500Medicaid