Provider Demographics
NPI:1922088236
Name:BOUTIN, ROBERT DOWNEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOWNEY
Last Name:BOUTIN
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 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-6855
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00064962085R0202X
DCMD0378722085R0202X
VA01012453692085R0202X
MDD00555992085R0202X
CO388012085R0202X
AZ287892085R0202X
WA025209MD000387872085R0202X
CAG812432085R0202X
MA1514102085R0202X
HIMD-122402085R0202X
TXL56832085R0202X
PAMD4183372085R0202X
OH35.0787022085R0202X
NJ25MA073889002085R0202X
NV96162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010111269Medicaid
DE1000025169Medicaid
PA19597630001Medicaid
WV1812213000Medicaid
VA010098866Medicaid
VA010098858Medicaid
MI104520410Medicaid
TX166689301Medicaid
MD402454100Medicaid
VA010118891Medicaid
PA070414N7WMedicare PIN
MD402454100Medicaid
WV1812213000Medicaid
DE1000025169Medicaid
MD192M315Medicare PIN
TX166689301Medicaid
VA010118891Medicaid
OH4069421Medicare PIN
TX8648B0Medicare PIN
MD193MD316Medicare PIN