Provider Demographics
NPI:1730263336
Name:ROBERT M PEPPERCORN MD INC
Entity type:Organization
Organization Name:ROBERT M PEPPERCORN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEPPERCORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-671-4182
Mailing Address - Street 1:350 DEL NORTE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-671-4182
Mailing Address - Fax:530-671-4835
Practice Address - Street 1:350 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-671-4182
Practice Address - Fax:530-671-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046090Medicaid
CAGR0046090Medicaid
CAZZZ24536ZMedicare ID - Type Unspecified
CAZZZ35006ZMedicare ID - Type Unspecified