Provider Demographics
NPI:1114940343
Name:HARGROVE, ROBERT HADLEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HADLEY
Last Name:HARGROVE
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 1:10 SIERRA GATE PLZ STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6647
Mailing Address - Country:US
Mailing Address - Phone:916-784-1155
Mailing Address - Fax:916-773-0995
Practice Address - Street 1:10 SIERRA GATE PLZ STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6647
Practice Address - Country:US
Practice Address - Phone:916-784-1155
Practice Address - Fax:916-773-0995
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46499207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO680021148OtherBLUE SHIELD
CA00G464990Medicaid
CA680021148OtherBLUE CROSS
CA680021148OtherUNITED HEALTHCARE
CA680021148OtherBLUE CROSS
CO680021148OtherBLUE SHIELD