Provider Demographics
NPI:1104824010
Name:GITLIN, ROBERT S (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GITLIN
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 1:8501 WEST RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9583
Mailing Address - Country:US
Mailing Address - Phone:707-485-6900
Mailing Address - Fax:707-485-6909
Practice Address - Street 1:8501 WEST RD
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9583
Practice Address - Country:US
Practice Address - Phone:707-485-6900
Practice Address - Fax:707-485-6909
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A64520Medicare ID - Type UnspecifiedMEDICARE ID
CAF69792Medicare UPIN