Provider Demographics
NPI:1235609348
Name:EBERHART, ROBERT N (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:EBERHART
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-247-5436
Mailing Address - Fax:510-506-7728
Practice Address - Street 1:4053 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6210
Practice Address - Country:US
Practice Address - Phone:510-247-6436
Practice Address - Fax:510-506-7728
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19252207Q00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A19252OtherSTATE MEDICAL LICENSE