Provider Demographics
NPI:1922020270
Name:MALONEY, ROBERT KELLER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KELLER
Last Name:MALONEY
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 1:10921 WILSHIRE BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4003
Mailing Address - Country:US
Mailing Address - Phone:310-208-3937
Mailing Address - Fax:310-208-0169
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE #900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-208-3937
Practice Address - Fax:310-208-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71227207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G712270OtherMEDICAL PPIN #
CAE62590Medicare UPIN