Provider Demographics
NPI:1265549588
Name:ENSOM, ROBERT THOMAS II (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:ENSOM
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:THOMAS
Other - Last Name:ENSOM
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:40 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93650-1239
Mailing Address - Country:US
Mailing Address - Phone:559-436-0482
Mailing Address - Fax:559-436-4650
Practice Address - Street 1:40 E. MINARETS AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:CA
Practice Address - Zip Code:93650
Practice Address - Country:US
Practice Address - Phone:559-436-0482
Practice Address - Fax:559-436-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG452472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265549588OtherNPI