Provider Demographics
NPI:1780777607
Name:ROBERT D VERRETTE, DPM,INC
Entity type:Organization
Organization Name:ROBERT D VERRETTE, DPM,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:VERRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-910-9436
Mailing Address - Street 1:10700 CROTHERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1730
Mailing Address - Country:US
Mailing Address - Phone:408-910-9436
Mailing Address - Fax:408-272-3903
Practice Address - Street 1:14981 NATIONAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:408-910-9436
Practice Address - Fax:408-272-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4486213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty