Provider Demographics
NPI:1588655823
Name:PEPPERCORN, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:PEPPERCORN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:#100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:530-671-4182
Mailing Address - Fax:530-671-4835
Practice Address - Street 1:350 DEL NORTE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4123
Practice Address - Country:US
Practice Address - Phone:530-671-4182
Practice Address - Fax:530-671-4835
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC38720207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36989Medicare UPIN
CAZZZ24536ZMedicare ID - Type Unspecified