Provider Demographics
NPI:1467405852
Name:OBLATH, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:OBLATH
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:PO BOX 572913
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2913
Mailing Address - Country:US
Mailing Address - Phone:818-774-1774
Mailing Address - Fax:818-704-4977
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:#607
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-774-1771
Practice Address - Fax:818-704-4977
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG390822086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390820Medicaid
CAP00317182OtherMEDICARE RAILROAD
CA00G390820Medicaid
CAWG39082EMedicare ID - Type UnspecifiedMEDICARE