Provider Demographics
NPI:1497864664
Name:EQUI, ROBERT ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:EQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 J ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3631
Mailing Address - Country:US
Mailing Address - Phone:916-454-6191
Mailing Address - Fax:916-454-1036
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3631
Practice Address - Country:US
Practice Address - Phone:916-454-6191
Practice Address - Fax:916-454-1036
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78901207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A789011OtherBLUE SHIELD
WA0199878OtherDEPT. OF LABOR WASHINGTON
CAP0022741OtherRAILROAD MEDICARE
CA00A789010Medicaid
CA00A789014Medicare PIN
CA00A789011OtherBLUE SHIELD
CA00A789010Medicaid
CA00A789012Medicare PIN
CAP0022741OtherRAILROAD MEDICARE
H66297Medicare UPIN
CA00A789015Medicare PIN