Provider Demographics
NPI:1730304023
Name:PRICE, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:768 PLEASANT VALLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9260
Mailing Address - Country:US
Mailing Address - Phone:530-621-6290
Mailing Address - Fax:530-622-1293
Practice Address - Street 1:768 PLEASANT VALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9260
Practice Address - Country:US
Practice Address - Phone:530-621-6290
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75414261QM0801X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)