Provider Demographics
NPI:1629000815
Name:HAIMSON, ROBERT BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:HAIMSON
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 1:325 DISTEL CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7799
Mailing Address - Fax:707-573-5431
Practice Address - Street 1:3883 AIRWAY DR STE 165
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1675
Practice Address - Country:US
Practice Address - Phone:707-521-7799
Practice Address - Fax:707-573-5431
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16934207X00000X
CAG64619207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64619OtherSTATE MEDICAL LICENSE
MS0122844Medicaid
MSF62771Medicare UPIN