Provider Demographics
NPI:1477596096
Name:HAYMOND, ROBERT SHELBY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SHELBY
Last Name:HAYMOND
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 309
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0309
Mailing Address - Country:US
Mailing Address - Phone:209-736-6760
Mailing Address - Fax:209-736-0450
Practice Address - Street 1:1300 KURT DR
Practice Address - Street 2:STE 102
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222
Practice Address - Country:US
Practice Address - Phone:209-736-6760
Practice Address - Fax:209-736-0450
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG070921207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0975590001OtherPALMETTO GBA
CAF03189Medicare UPIN