Provider Demographics
NPI:1861657710
Name:ROBERT J. MEHLER, MD, INC.
Entity Type:Organization
Organization Name:ROBERT J. MEHLER, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-801-7300
Mailing Address - Street 1:416 W LAS TUNAS DR
Mailing Address - Street 2:#205
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-281-7461
Mailing Address - Fax:626-281-8827
Practice Address - Street 1:416 W LAS TUNAS DR
Practice Address - Street 2:#200
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1236
Practice Address - Country:US
Practice Address - Phone:626-281-7461
Practice Address - Fax:626-281-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12425207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G12425Medicaid
CAG12425Medicare PIN
CAA38671Medicare UPIN