Provider Demographics
NPI:1477550960
Name:FIERER, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:FIERER
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 1:11857 KEOUGH DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1221
Mailing Address - Country:US
Mailing Address - Phone:720-401-2340
Mailing Address - Fax:
Practice Address - Street 1:10050 RALSTON RD # 1 - B/E
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-4974
Practice Address - Country:US
Practice Address - Phone:720-401-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049839207RA0401X, 207R00000X
COAF6214960251S00000X
PAMD035627L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000198814Medicaid
PA01066001OtherCAPITAL BLUE CROSS
10926627OtherCAQH
110031885OtherRAILROAD MEDICARE
PA134085OtherHIGHMARK BLUE SHIELD
B38056Medicare UPIN
0000134085OtherKEYSTONE HEALTH PLANS
B38056OtherHEALTH AMERICA
PA18425 S154OtherGEISINGER HEALTH PLANS
479897OtherAETNA