Provider Demographics
NPI:1568502839
Name:JACKLER, ROBERT KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:JACKLER
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 1:801 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1611
Mailing Address - Country:US
Mailing Address - Phone:650-725-6500
Mailing Address - Fax:
Practice Address - Street 1:801 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1611
Practice Address - Country:US
Practice Address - Phone:650-725-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43573207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G435730Medicaid
CA00G435732Medicare ID - Type Unspecified
CA00G435730Medicaid