Provider Demographics
NPI:1275506289
Name:MODIC, ROBERT ALBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALBIN
Last Name:MODIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-969-3551
Mailing Address - Fax:480-644-0692
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:SUITE 223
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-969-3551
Practice Address - Fax:480-644-0692
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ7739207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99997Medicare UPIN