Provider Demographics
NPI:1124001862
Name:MAIRS, ROBERT A (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MAIRS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9376
Practice Address - Street 1:840 SW 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2638
Practice Address - Country:US
Practice Address - Phone:541-881-2800
Practice Address - Fax:541-881-2825
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO20644207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804163300Medicaid
ID1139391Medicare ID - Type Unspecified
ID804163300Medicaid
ORF87750Medicare UPIN
OR150184Medicaid