Provider Demographics
NPI:1871502211
Name:JABLONSKY, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:JABLONSKY
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 1:2505 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1401
Mailing Address - Country:US
Mailing Address - Phone:559-457-5500
Mailing Address - Fax:559-457-5599
Practice Address - Street 1:2505 E DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1401
Practice Address - Country:US
Practice Address - Phone:559-457-5500
Practice Address - Fax:559-457-5599
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46510207R00000X
CA46510208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A465100Medicaid
CARHM53898FMedicaid
CA00A465102Medicaid
A65010Medicare UPIN
CARHM53898FMedicaid