Provider Demographics
NPI:1861429060
Name:POUSMAN, ROBERT MARC (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARC
Last Name:POUSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20612 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5403
Mailing Address - Country:US
Mailing Address - Phone:310-774-6472
Mailing Address - Fax:
Practice Address - Street 1:6815 NOBLE AVE
Practice Address - Street 2:STE#400
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3796
Practice Address - Country:US
Practice Address - Phone:818-901-6690
Practice Address - Fax:818-901-6699
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9252207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX92520Medicaid
CA020A92520OtherBLUE SHIELD OF CA
CAW20A9252AMedicare ID - Type Unspecified
CAED660ZMedicare PIN
CA020A92520OtherBLUE SHIELD OF CA