Provider Demographics
NPI:1275553893
Name:MCLEOD, ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 N ANGUS ST
Mailing Address - Street 2:APT. 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6151
Mailing Address - Country:US
Mailing Address - Phone:559-999-5282
Mailing Address - Fax:
Practice Address - Street 1:450 OLLER ST
Practice Address - Street 2:STE 101
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-2382
Practice Address - Country:US
Practice Address - Phone:559-655-1000
Practice Address - Fax:559-655-7402
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA112070Medicare ID - Type Unspecified