Provider Demographics
NPI:1508858465
Name:FISHBURN, ROBERT IRL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:IRL
Last Name:FISHBURN
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:DEPT 9697
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-9697
Mailing Address - Country:US
Mailing Address - Phone:949-721-6520
Mailing Address - Fax:949-721-6120
Practice Address - Street 1:100 CASA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1883
Practice Address - Country:US
Practice Address - Phone:805-541-1932
Practice Address - Fax:805-541-1653
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA243952085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology