Provider Demographics
NPI:1649221060
Name:DEERE, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:DEERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5010
Mailing Address - Country:US
Mailing Address - Phone:562-904-1651
Mailing Address - Fax:562-904-1656
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5010
Practice Address - Country:US
Practice Address - Phone:562-904-1651
Practice Address - Fax:562-904-1656
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54147208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54573ZOtherBLUE SHIELD
CAGR0080690Medicaid
CA0004023193OtherAETNA
CAGR0080690OtherMEDI-CAL
CA020014065OtherPALMETTO RAILROAD MEDICARE
CAGR0080690OtherMEDI-CAL