Provider Demographics
NPI:1073518106
Name:MALSTROM, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:MALSTROM
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 1:4626 WILLOW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2710
Mailing Address - Country:US
Mailing Address - Phone:925-463-0470
Mailing Address - Fax:925-463-0473
Practice Address - Street 1:4626 WILLOW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2710
Practice Address - Country:US
Practice Address - Phone:925-463-0470
Practice Address - Fax:925-463-0473
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG031561207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200008241OtherMEDICARE RAILROAD
CA200008241OtherMEDICARE RAILROAD
CAA44807Medicare UPIN
CA00G315614Medicare PIN
CA00G315615Medicare PIN
CA00G315613Medicare PIN
CA00G315611Medicare PIN
CA00G315612Medicare PIN