Provider Demographics
NPI:1073507786
Name:DEBRUIN, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DEBRUIN
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 1:1600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3444
Mailing Address - Country:US
Mailing Address - Phone:916-984-7830
Mailing Address - Fax:916-984-7887
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 3800
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-984-7830
Practice Address - Fax:916-984-7887
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G426560Medicaid
CA00G426560Medicare ID - Type Unspecified
CA00G426560Medicaid