Provider Demographics
NPI:1477543841
Name:DEBOS, ROBERT J (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DEBOS
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1051 E TUOLUMNE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1546
Mailing Address - Country:US
Mailing Address - Phone:209-216-5900
Mailing Address - Fax:209-216-5909
Practice Address - Street 1:1051 E TUOLUMNE RD
Practice Address - Street 2:STE 103
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1546
Practice Address - Country:US
Practice Address - Phone:209-216-5900
Practice Address - Fax:209-216-5909
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18117363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ56764Medicare UPIN
CA0PA1881170Medicare ID - Type Unspecified