Provider Demographics
NPI:1861771594
Name:FIRE, ROBERT E (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:FIRE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 EAST LOOP
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4946
Mailing Address - Country:US
Mailing Address - Phone:559-662-8818
Mailing Address - Fax:
Practice Address - Street 1:54 EAST LOOP
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4946
Practice Address - Country:US
Practice Address - Phone:559-662-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner