Provider Demographics
NPI:1861548208
Name:EGERT, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:EGERT
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 1:552 VALLOMBROSA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4038
Mailing Address - Country:US
Mailing Address - Phone:530-343-8438
Mailing Address - Fax:530-343-2609
Practice Address - Street 1:552 VALLOMBROSA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4038
Practice Address - Country:US
Practice Address - Phone:530-343-8438
Practice Address - Fax:530-343-2609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49684208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE52565Medicare UPIN
CA00A496840Medicare PIN